Top Ten Things You Need to Know about the “No Surprises Act”

At the end of December of 2020, Congress passed the “No Surprises Act”, and put an end to many surprise medical bills for individuals across the country.  This will ensure that people can get medical care without worrying about harmful surprise medical bills in many situations.

Surprise medical bills occur when a patient, usually at no fault of their own, receives out-of-network care. These bills often happen following an emergency, like a heart attack or serious car accident, when patients don’t have the chance to choose who provides their care or when a patient needs a lab test or procedure.

Here are the top 10 things you need to know about the No Surprises Act and surprise medical bills going forward:

1. What does the Act do?
   The No Surprises Act bans surprise medical bills in many, but not all emergency and non-emergency situations for individuals with coverage through their employer, the ACA marketplace, or who purchase their own insurance. Medicare and Medicaid already had protections against surprise medical bills.
2. How does this affect me?
   You will no longer be held liable for out-of-network costs outside of your control and will only be required to pay your usual out-of-pocket cost.
3. What about ambulance bills?
   Ambulance trips are a major source of surprise medical bills. The No Surprises Act protects individuals from surprise medical bills that come from air ambulance trips, but not ground ambulance trips.
4. Are there any other circumstances in which people could get billed for out-of-network care?
   There may be some instances in which you could still get a surprise bill for a diagnostic test, image, lab, or procedure. Additionally, in non-emergency situations, healthcare providers may present patients with notice that certain doctors are out-of-network and ask these patients to waive their protections under this Act. This presents a challenging decision for patients who are still caught off-guard by these providers. PHAN will watch this carefully.
5. Does this law benefit patients, doctors, or insurance companies?
   Overall, the law is a win for patients. Both insurance plans and doctors had to compromise in order to protect patients from surprise bills.
6. How will doctors and other healthcare providers be paid for out-of-network care?
   In order for doctors to get paid for their service, they have 30 days to negotiate a fair price with the insurance company. If they cannot agree on a price, a neutral third party will decide.
7. What happens to the legislation proposed in Pennsylvania to put an end to surprise medical bills?
   Because the No Surprises Act ends surprise medical bills nationwide, Pennsylvania no longer needs to pass this protection at the state level.
8. Does that mean PHAN is done working on this issue?
   No! The work isn’t done yet. PHAN will keep pushing our elected officials in Harrisburg to strengthen surprise medical bill protections by eliminating surprise medical bills that come from ground ambulance services. PHAN will also be watching closely as the law comes into effect nationally to ensure the protections are really working for people in Pennsylvania.
9. When does the No Surprises Act take effect?
   The law takes effect in 2022.
10. What should I do if I get a surprise bill in the meantime? 
    If you receive a surprise medical bill before or after the No Surprises Act comes into effect, file a complaint with the PA Insurance Department and/or call PHAN’s helpline at 877-570-3642 to get the bill resolved.