“No Surprises Act” takes full effect protecting consumers from unforeseen medical bills

The "No Surprises Act" (NSA), a provision of the Consolidated Appropriations Act of 2021, signed into law by then-President Donald Trump in late December 2020, protects consumers from surprise bills from the emergency room.

The COVID-19 pandemic threw into relief a problem that has been plaguing patients for decades: surprise bills from "out-of-network" providers they had no choice but to use. An example would be when someone arrives unconscious at the emergency room. Their surgeon might be "in-network," therefore covered except for copayments and deductibles. On the other hand, the anesthesiologist might be "out-of-network." The patient had no say in who they worked with, and the hospital was working to save their lives, not calculate insurance bills. Later, the patient might receive a massive bill from some service providers because those providers didn't have a relationship with the patient's insurance company.

The NSA now forces the insurance companies to negotiate a reasonable fee with the provider, leaving the patients only to pay their copays and deductibles. This bill takes some of the fear out of emergency room bills.

The Center for Medicare and Medicaid Services (CMS) lists all of the new rights the Act provides to patients:

  • “Ban surprise bills for emergency services, even if you get them out-of-network and without approval beforehand (prior authorization).
  • “Ban out-of-network cost-sharing (like out-of-network coinsurance or copayments) for all emergency and some non-emergency services. You can’t be charged more than in-network cost-sharing for these services.
  • “Ban out-of-network charges and balance bills for supplemental care (like anesthesiology or radiology) by out-of-network providers who work at an in-network facility.
  • “Require that health care providers and facilities give you an easy-to-understand notice explaining that getting care out-of-network could be more expensive and options to avoid balance bills. You’re not required to sign this notice or get care out-of-network.”

CMS also notes that those who don’t have insurance or choose to pay cash must receive a “good faith” estimate of services to prevent billing surprises.

Consumers wishing to file a billing complaint can do so through the CMS website:

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