Patients will no longer have to worry about paying unexpected expensive medical bills starting 2022. In late 2020, Congress passed the No Surprises Act, 2022, which prohibits providers from offering patients emergency care and ancillary services, such as anesthesiology, at out-of-network rates. The rule applies to services delivered during scheduled procedures at in-network facilities.
With the implementation of the No Surprises Act, doctors will need patients’ consent to charge out-of-network rates. In specialties like anesthesiology, patients hardly get a say in deciding who treats them. From 2022, while billing the patient, insurers will be required to bill these out-of-network services as they would in-network ones. A violation can cost providers and facilities a fine of up to $10,000.
Some out-of-network providers at in-network facilities can charge patients higher rates for scheduled procedures if they provide an estimated bill at least 72 hours before and the patient agrees. For procedures scheduled during the 72-hour window, the provider must inform the patient about the higher cost when the latter makes the appointment. The legislation also applies to air ambulances, but not ground ambulances. Medicaid and Medicare will remain unaffected by the law because they already ban balance billing, which refers to the patient getting charged the difference between the doctor’s bill and what the insurer will pay.
When the No Surprises Act comes into effect, insurers and medical providers will settle the disputes over these surprise bills. If they are unable to agree, the case will go to arbitration. The arbitrators’ decisions could affect health insurance premiums. According to predictions by the Congressional Budget Office, health insurance premiums could decrease by up to 1% because some providers receive lower payments. However, the arbitrators may side with the providers too, which will increase the premiums.