Law prohibiting ‘surprise’ medical bills finally goes into effect

A new law is about to take effect that is expected to decrease the price of medical bills — to the tune of millions of dollars.

According to the Washington Examiner, the law, which prohibits patients from being surprised with out-of-network costs, is known as the No Surprises Act.

What will it do?

“The underlying issue is relatively straightforward: Americans often go to emergency rooms in a crisis and assume their visit will be covered by insurance. But as part of their emergency care, patients are often treated by out-of-network medical professionals, who don’t have contracts with the relevant insurer, which means consumers end up receiving ‘surprise’ invoices, which can be quite expensive,” MSNBC reported.

As its name suggests, what the law does is make sure that people who have private insurance don’t receive surprise, out-of-network bills for emergency services or procedures outsourced by an in-network doctor or facility.

The act accomplishes this by requiring, according to MSNBC, “health providers to negotiate fair prices with insurers, relying on outside arbiters as needed.”

It should be noted, however, if a private insurance holder chooses, of his or her own volition, to go out-of-network, it is a different story.

In that case, even with the No Surprises Act, the individual will have to pay up.

Bipartisan support

The No Surprises Act made it through Congress in December of 2020. The bill received bipartisan support, as it should have. But, as you might expect, insurance agencies and healthcare providers had quite a bit to say about it, as it will certainly cut into their soaring annual profits.

Medical groups have responded to the No Surprises Act with a number of lawsuits looking to halt it from taking effect. A common argument was that it unfairly benefits insurance providers. These cases are still being litigated.

Nonetheless, former President Donald Trump signed the law into effect last January. In July, President Joe Biden’s administration issued a rule that put the new rules into effect.

“No patient should forgo care for fear of surprise billing,” Health and Human Services (HHS) Secretary Xavier Becerra said at the time, according to the Examiner. “Health insurance should offer patients peace of mind that they won’t be saddled with unexpected costs.”

The No Surprises Act goes into effect on Jan. 1, 2022.

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