Keep this in mind for 2022
Starting next year, out-of-network health care providers can no longer ambush patients with an unexpected, exorbitant bill. Instead, doctors will need a patient’s consent first to charge an out-of-network rate. “People generally thought surprise medical bills were unfair. There is an element of being blindsided,” says Daniel Klein, president and CEO of the advocacy group Patient Access Network Foundation. The reform could lower health insurance premiums, too.
The No Surprises Act, which Congress passed late last year, prohibits providers from charging patients out-of-network rates for emergency care and ancillary services, such as anesthesiology, delivered during scheduled procedures at in-network facilities.
Specialties, such as anesthesiology, where hospital patients get little say in who treats them, have long been a sore point. “You don’t even know the name of your doctor until the bill comes,” says Karen Pollitz, senior fellow at the Kaiser Family Foundation, a nonprofit that studies health policy. As of 2022, insurers must treat these out-of-network services as if they were in-network on a patient’s bill. Providers and facilities can be fined up to $10,000 per violation.
For scheduled procedures, some out-of-network providers at in-network facilities can charge the higher rates if they give the patient an estimated bill at least 72 hours in advance and the patient consents. For procedures scheduled within that 72-hour window, the patient must be notified about the higher cost the day the appointment is made. The law also applies to air ambulances but not ground ambulances, which are more complicated to regulate, Pollitz says. The legislation won’t affect Medicare or Medicaid, as these programs already ban “balance billing,” which is when a patient is charged the difference between the doctor’s bill and what insurance will pay.