Protections from Surprise Medical Bills: What Patients Need to Know
On January 1, 2022, the No Surprises Act went into effect. This new law protects patients from unexpected or “surprise” medical bills. Surprise bills can occur after emergency services (like an ambulance or emergency room visit) are utilized, or when a patient received care at an in-network medical center or hospital but saw an out-of-network doctor or other health care provider. “Out-of-network” describes doctors and other health care providers, medical centers, and hospitals that haven’t signed a contract with your health plan.
Now, you are protected from surprise bills when you receive emergency services or care at an in-network hospital or center by an out-of-network doctor.
What Are Surprise Medical Bills?
If you seek care out-of-network, your health insurance may not cover the entire cost. This can leave you with higher costs than if you got care from an in-network doctor or medical facility, which is known as “balance billing.”
A “surprise bill” is an unexpected balance bill. Surprise medical bills often occur when patients had little ability to choose where they received care, like when a patient needs an ambulance or goes to an emergency room. They also happen in non-emergencies where patients seek care at an in-network center or hospital but unknowingly receive support services from an anesthesiologist, radiologist, or other health care professional who is not in-network.
Surprise medical bills are a major cause of concern for patients and families. A 2019 survey of cancer patients and survivors found that 24% of patients had received a surprise medical bill and that over 20% were for $3,000 or more (ACS CAN, 2019). Patients reported that the surprise bills created additional stress and anxiety, with many reporting they were less likely to follow up with a recommended specialist or call for emergency services, fearing another surprise bill.
New Protections for Patients
The No Surprises Act bans common surprise bills for people who have insurance through their job or a health insurance marketplace (HealthCare.gov or a state-based marketplace), or who pay for a plan directly from an insurance company. The new law:
- Bans surprise bills for most emergency services, even if you get them out-of-network
- Bans balance bills for certain services (like anesthesiology or radiology) when provided by out-of-network doctors and other health care professionals at in-network medical centers or hospitals
- Bans surprise bills for air ambulances
Health care professionals and medical facilities are also now required to give patients a clear explanation of applicable billing protections. This explanation includes who to contact if the patient is concerned that their protections have been violated as well as that patient consent is required to waive billing protections. The new law provides a way for patients to appeal certain health plan decisions.
If you do not have insurance, this new law requires medical facilities and health care providers to give patients a “good faith estimate” of services before they receive care. This allows patients to better understand their costs up front. If the final bill exceeds the good faith estimate by more than $400, the patient can dispute the charges.
Note: If you have health insurance through Medicare, Medicaid, Indian Health Services, Veterans Affairs Health Care, or TRICARE, you’re already protected against surprise medical bills.
Understanding Your Rights
If you are concerned that your rights have been violated, or you need more help understanding your rights under the new law, reach out to our Cancer Support Helpline by phone or online. Our experienced Helpline staff are here to offer free navigation for cancer patients and their loved ones.
American Cancer Society Cancer Action Network. (2019). Survivor views: Surprise billing and prescription cost and coverage survey findings summary.
Assistant Secretary for Public Affairs. (2022). HHS kicks off New Year with new protections from surprise medical bills.