Now that the federal government has banned most surprise medical billing, insurers and providers are beginning to sort out the complexities of implementing the No Surprises Act. Experts are unsure whether the law will slow cost and premium growth, and have concerns that providers will attempt to influence HHS’s in-process rulemaking to drive up prices over the long haul.
The No Surprises Act was passed in December 2020 as part of the Consolidated Appropriations Act, which was otherwise mainly oriented toward pandemic relief. The surprise billing ban, which comes into full effect in 2022, prohibits providers from sending a balance bill to patients. Patients who are treated by an out-of-network provider while incapacitated will pay the same cost sharing that they would have if they had been treated by an in-network provider. Patients treated at an in-network facility by an out-of-network provider will also not be balance billed, unless they authorize care by that provider in written form at least 72 hours in advance. That authorization must be accompanied by the patient’s in-network options and an estimate of the costs that they will incur.