Current Events Health Insurance Public Policy

No surprise bills?

In a February 10th speech, President Biden wanted to end surprise bills for patients. Specifically he said:

No more surprise billing.  No more.

In fact, he proposed the No Surprises Act. Key questions you may have include: what is a surprise bill? are there any exceptions to this rule?

Kaiser Health News has a nice summary of what ‘no surprise bills’ does and does not cover. Surprise bills occur when a patient unintentionally visits an out-of-network provider and is stuck with a large bill for the service since the provider wasn’t in their insurer’s preferred network.

The No Surprises Act primarily protects consumers against certain types of medical bills: those received by patients for care at an out-of-network facility — specifically, a hospital, a hospital outpatient department, or an ambulatory surgery center; or from an out-of-network medical provider whom patients did not get to choose. The act also protects patients from “surprise” bills from an out-of-network air ambulance transport. Out of network means the doctor doesn’t take your medical insurance or isn’t included on the list of approved providers in your insurance network.

There are some exceptions to this rule, however. While air ambulance are included in no surprises, ground ambulance are not covered, so you may get a surprise bill for that. Also, “surprise bill” does not mean that patients cost sharing is capped; patients may have large bills if they see in-network providers, especially if they have high-deductible health plans. Additionally, health care providers may be able to ask patients to sign written consent form that waives their rights under the No Surprises Act; since the patient signed the form, this wouldn’t be a surprise even though the provider likely won’t be able to tell the patient what their true out-of-pocket cost will be at the time of the service.

Kaiser Health News also notes that “…consumers can still be subject to huge fees because of hospital overcharges or insurer mistakes.”

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