Washington DC: Patients with insurance will no longer receive so-called “surprise bills” following emergency medical care from an out-of-network doctor or facility. In December 2020, Congress passed a $900 billion COVID-19 relief bill that included the main provisions of the law coming into effect on January 1, 2022.
Patients will still be responsible for any deductibles and copays they normally would have to pay under their plan, but they may only be billed at their plan’s in-network rate.
One of the many constants of American medical care in the past few years has been the unexpected: Surprise medical bills. Around one in every six times someone checks into the hospital, or is taken to an emergency room, the treatment is followed by a surprise medical bill, a 2019 study found. But as of January 1, 2022, federal law now bans many types of surprise medical bills.
Patients will also be protected if an out-of-network clinician is involved in a planned procedure at an in-network hospital, like if a surgeon is called in to assist during an operation, or a patient’s anesthesiologist is out-of-network.
The law also requires out-of-network providers to give patients notice of their charges 72 hours in advance of a planned procedure. Patients will have to agree to receive out-of-network care to be billed. If a patient receives unexpected out-of-network care, health service providers and insurers will now be responsible for submitting their billing disputes to an independent arbiter.
“Generally speaking, keeping the consumer out of it and forcing the providers to be the ones to settle is a positive,” said Eagan Kemp, a policy expert with Public Citizen, a liberal advocacy group, also told AP.