Thousands of Americans face unexpected medical bills every year. Simply having health insurance is not enough for many to avoid this reality. Many hospitals have made it difficult for average Americans to determine whether they are in-network, in which their insurance will cover the expenses, or out-of-network, where the individual may be responsible for all of the medical charges. Many Americans do not have savings to combat these unexpected charges, which medical debt that could involve debt collectors and watching that debt increase due to accrued interest. Congress has taken notice of this significant issue, and has recently passed the No Surprise Act to alleviate this problem facing United States citizens.
The No Surprise Act is a new law which removes the patient’s financial responsibility for any out of network extra charges. This law will come in effect January 2022. Patients will just be required to pay the deductible and the co-payments that they would have had to pay had they been in-network. The No Surprise Act requires medical providers and insurers to work it out between themselves to determine the ultimate amount which will be paid. If an agreement cannot be reached, the matter will be sent to arbitration. The arbitrator will view everyone’s best offers and pick one, and that is what the insurer will pay.
While this will greatly reduce the amount of out-of-network surprise hospital bills that many receive, there are some exemptions to this law. For example, ground ambulances are not included in this new law. This means if your ground ambulance is not in-network, you can still receive a rather large bill that you will be responsible for. Additionally, this law is not retroactive. If you have incurred any debt from surprise medical bills prior to 2022, you will still be responsible for that debt. Individuals must also be aware that you are able to waive the rights under the No Surprise Act if you give prior written consent to do so, and can be billed more by out-of-network providers. Providers cannot ask patients to waive their rights for emergency services, or other certain non-emergency services. Consent cannot be coerced and must be voluntarily given, but providers can refuse care if consent is denied.
This is one of the first steps to help lessen the burden placed on citizens due to medical debt, and will hopefully help many individuals in the upcoming years.