January 5, 2022 by Clarissa Ayala
No Surprises Act – New Federal Law Prohibits Surprise Medical Bills
Houston, TX – The No Surprises Act (NSA) establishes new federal protections against surprise medical bills.
If you’ve ever received a surprise bill after a trip to an emergency room, after thinking it would be covered by insurance, it was due to something called balanced billing. Balance billing occurs when an insured patient receives care from a physician, hospital or other health care provider, who is not part of a patient’s health plan provider network. The out-of-network provider then bills the patient directly for the portion of medical expenses not covered by insurance, typically at a much higher rate.
Effective now, patients with insurance will no longer receive “surprise bills” following emergency medical care from an out-of-network doctor or facility. The federal government estimates the NSA will apply to about 10 million out-of-network surprise medical bills a year.
Patients will also be protected if an out-of-network physician, hospital or other health care provider is involved in a planned procedure at an in-network hospital. For example, if an out-of-network surgeon is called in to assist during an operation, or if a patient’s anesthesiologist is out-of-network.
The law also requires out-of-network physicians, hospitals or other health care providers to notify patients 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 health insurance plans will be the responsible party for submitting their billing disputes to an independent arbiter.
Providers must notify patients of their federal protections each time they provide a service protected under the NSA. The notice must include contact information for the applicable federal and state enforcement entities where they can appeal.
If a health insurance plan or health service provider (or both) fail to properly identify a surprise bill, it will be up to the patient to recognize that NSA protections apply and ask for help.
The Department of Health and Human Services has established a national complaints system for surprise medical bills. The toll free number for the “No Surprises Help Desk” will be 1-800-985-3059.
If you or someone you know needs help with a surprise medical bill, you can apply for free legal help by visiting https://www.lonestarlegal.org.
Lone Star Legal Aid is a 501(c)(3) nonprofit law firm focused on advocacy for low-income and underserved populations. Lone Star Legal Aid serves millions of people at 125% of federal poverty guidelines that reside in 72 counties in the eastern and Gulf Coast regions of Texas, and 4 counties of Southwest Arkansas. Lone Star Legal Aid focuses its resources on maintaining, enhancing, and protecting income and economic stability; preserving housing; improving outcomes for children; establishing and sustaining family safety and stability, health and well‐being; and assisting populations with special vulnerabilities, like those with disabilities, or who are elderly, homeless, or have limited English language skills. To learn more about Lone Star Legal Aid, visit our website at https://www.lonestarlegal.org.
Media contact: Media@LoneStarLegal.org
https://www.congress.gov/bill/116th-congress/house-bill/133/text
