New legislation shields consumers from unexpected charges
Starting January 1, 2022, the federal No Surprises Act protects consumers from excessive out-of-pocket costs.
This new law sees to it that when plan members receive emergency medical care, or are treated by out-of-network providers at in-network facilities, they’re protected against surprise billing.
Emergency services will continue to be covered without prior authorization, and regardless of whether a provider or facility is in-network.
Plan members cannot be balance billed for:
- Emergency Services
If members have an emergency medical situation and get services from an out-of-network provider or facility, the most the provider or facility may bill the member is their plan’s in-network cost-share. Members can’t be balance-billed for these emergency services. - Certain services at in-network hospitals or ambulatory surgical centers
For out-of-network providers at in-network facilities: The most such providers may bill a member is their plan’s in-network cost-share. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeons, hospitalists, or intensivist services.
If members receive other services at these in-network facilities, out-of-network providers can’t balance-bill them unless the member gives written consent to waive their protections.
Members are never required to give up protections from balance billing. They also aren’t required to get care out of network. They can choose a provider or facility in their plan’s network.
To learn more about consumer rights under federal law, visit www.cms.gov/nosurprises.