The No Surprises Act Offers Key Protections for Patients Against Unexpected Charges

As of 1 January, the No Surprises Act has banned most unexpected medical bills, offering relief to many Americans who worry about unforeseen healthcare costs. Surveys by the Kaiser Family Foundation in 2018 and 2020 revealed that surprise medical bills top the list of financial concerns for Americans.

A 2020 Peterson-KFF Health System Tracker study found that 18% of emergency visits and 16% of in-network hospital stays included at least one out-of-network charge. This law aims to alleviate such issues. “Patients will no longer face excessive charges for out-of-network care they didn’t choose,” stated Senator Patty Murray, chair of the Senate Health, Education, Labour, and Pensions Committee.

What Defines a Surprise Medical Bill?
A surprise medical bill arises when a patient unknowingly receives care from an out-of-network provider, often during emergencies or when ancillary services like anaesthesia or lab work are provided at an in-network hospital. Patients are then left with “balance bills,” where providers charge the remainder after the insurer’s payment.

How the No Surprises Act Protects Patients
The act prohibits balance billing for:

Emergency services, even at out-of-network facilities.
Nonemergency care at in-network hospitals, including services like radiology, anaesthesia, and pathology.
Patients are required to pay only in-network copays, coinsurance, or deductibles. If an out-of-network provider is preferred, they must provide clear information about costs and obtain written consent to proceed. However, experts advise caution before waiving these protections.

Disputes and Cost Transparency
The law ensures patients receive good-faith cost estimates for out-of-pocket expenses. If charges exceed estimates by $400 or more, patients can dispute the bill. Insurers must also provide detailed coverage and cost information.

To address disagreements between providers and insurers, the act establishes a neutral arbitration process, shielding patients from involvement while aiming to control long-term healthcare costs.

What Isn’t Covered?
The act does not eliminate all surprise bills. Notably:

Ground ambulances are excluded, although air ambulances are covered.
Clinics and urgent care centres fall outside its scope, though future updates may include them.
Medicare, Medicaid, TRICARE, and other government programmes already protect beneficiaries from such charges.

Will This Law Reduce Healthcare Costs?
The Congressional Budget Office predicts the No Surprises Act could lower health insurance premiums by 0.5% to 1%, potentially reducing costs for both patients and the government.

This law marks a significant step in protecting patients from unexpected financial burdens while promoting fairness in healthcare billing practices.