The No Surprises Act significantly changes how providers and commercial health insurance plans engage with patients and each other. The regulation is complex and continues to evolve based on public comment and pending lawsuits.
The No Surprises Act, effective Jan. 1, 2022, establishes new patient protections against surprise medical bills (that is, unexpected balance billing, in which consumers are billed for the difference between what an out-of-network (OON) provider bills and what the patient’s health plan covers). Surprise bills arise when insured patients receive care from OON hospitals, doctors, or other providers they did not choose. Examples of patient protections included in the act are as follows:
- Surprise billing for most emergency services is banned. Emergency services, regardless of where they are provided, must be treated and billed on an in-network basis without requirements for prior authorization, unless the patient signs a notice of consent.
- OON charges for ancillary services (such as anesthesiology or radiology) at an in-network facility are banned.
- Air ambulance services from OON providers are banned.