Most Americans have heard stories about surprise medical bills that can cost unknowing patients thousands of dollars for what they may have thought were simple or necessary procedures. However, the practice of surprising patients with medical bills may soon be a thing of the past.
The federal No Surprises Act, passed last year, went into effect on Jan. 1, 2022. It’s designed to protect Americans against these kinds of surprise medical bills. More specifically, the bill prevents providers from charging patients over what their insurer pays, a practice known as “balance billing.” It should be noted that there are certain caveats that relate to a patient’s health insurance and whether they receive care at an in-network facility. There are other important things to know about the No Surprises Act, and managing your healthcare costs and your finances can be complicated. A financial advisor may be able to help you get things in order. Check out SmartAsset’s free advisor matching tool to find an advisor in your area.
What Is The No Surprises Act?
The No Surprises Act was passed in 2021 but went into effect at the beginning of this year on Jan. 1, 2022. Simply put, the No Surprises Act is designed to prevent medical providers from engaging in the practice known as “surprise billing,” when unknowing patients are subject to medical bills in the thousands of dollars that they didn’t expect. Surprise billing often occurs when a provider charges a patient for the amount over what the insurer pays, known as “balance billing.”
It’s important to note that not just any big hospital bill is considered a surprise bill. The example of balance billing is the most common surprise bill, as the provider is charging the patient for what they would normally owe with insurance in addition to costs that go above what the insurer pays to the hospital. While many preferred providers do not balance bill patients, others do, and these charges are often referred to as surprise bills. The term also applies to any amount that an out-of-network provider might charge a patient.
Under the No Surprises Act, patients are covered from surprise billing under most circumstances. Specifically, patients won’t be subject to surprise bills when receiving “most emergency services, non-emergency services from out-of-network providers at in-network facilities, and services from out-of-network air ambulance service providers,” according to CMS.gov.
How Does It Work?
Luckily, there isn’t much that you as a medical patient will have to do to take advantage of the No Surprises Act. Several states also have existing laws that relate to surprise medical billing, and the No Surprises Act will serve to supplement any existing protections, particularly when it comes to help with enforcement.
If you believe that you’ve been subject to a surprise medical billing that exceeds what you’re supposed to be liable to pay, you have recourse under the No Surprises Act. All you’ll need to do is make sure that you file a dispute within 120 days of the date on your bill. You can first appeal to the health plan itself, and then you can appeal to an independent external reviewer.
More specifically the new law requires private health plans themselves to cover out-of-network claims while also applying in-network cost sharing. The new law also stops doctors, hospitals and other providers from billing patients more than the in-network cost sharing amount for medical bills.
Pros and Cons
There isn’t much argument over whether the No Surprises Act is a win for consumers of healthcare. Americans are protected against artificially high medical bills, often for basic or life saving treatments. The No Surprises Act covers a wide range of different scenarios, ensuring that Americans can get the help they need for reasonable prices.
However, not everyone is happy about the No Surprises Act. Many private practices, particularly those backed by private equity giants, have built businesses on the practice of surprise billing. With the No Surprises Act officially in place, many of these practices will see pressure to join larger insurance networks. However, it’s also important to keep tabs on the status of the No Surprises Act, as it’s currently facing several lawsuits and could change in the future.
How Will The No Surprises Act Affect You?
As noted in the section about how the No Surprises Act works, there isn’t much you have to do to take advantage of the provisions. It’s now illegal for medical practices and facilities to engage in surprise billing, and you’ll have legal recourse if you’ve been a victim of surprise billing.
Perhaps the biggest affect that the No Surprises Act will have on you as a consumer of healthcare is that you won’t have to worry as much about surprise medical bills anymore. You can go to the doctor, the emergency room and other providers with the peace of mind that you won’t be faced with bills that you didn’t anticipate – or if you are then you’ll have a clear course of action to appeal.
Provisions in the No Surprises Act officially went into effect on Jan. 1, 2022, which means that you and your loved ones should be protected against surprise medical billing. Not only is it now illegal for medical facilities and practices to engage in balance billing and over overcharging schemes, but you’ll have legal recourse if you are subject to such practices. This is a huge win for Americans everywhere, as you won’t have to worry about surprise medical bills provided that you operate within the protection limits outlined in the bill. If you’re having trouble managing medical expenses, consider working with a financial advisor.
Tips for Managing Medical Expenses
- Managing your finances can be difficult by itself. When you add medical expenses, things can get downright perplexing. A financial advisor may be able to help. Finding a qualified financial advisor doesn’t have to be hard. SmartAsset’s free tool matches you with up to three financial advisors in your area, and you can interview your advisor matches at no cost to decide which one is right for you. If you’re ready to find an advisor who can help you achieve your financial goals, get started now.
- If you’re managing your finances without the help of a professional, it pays to be prepared. SmartAsset has you covered with tons of free online resources designed to help you take control of your finances. For example, check out our free investment calculator and get started today.
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