Congress Takes the Surprise Out of Surprise Billings

Consumers can look forward to January 2022 as an end to unexpected — or “surprise” — medical bills. Congress passed a bill in December to stop this practice. Surprise medical bills, also referred to as balance billing, occur when patients are billed for care received from out-of-network providers where insurance covers none or only a small portion of the costs.

This sometimes happens accidently. Patients often choose in-network hospitals, only to later discover that a provider working at the hospital is not in-network. The legislation comes after two years of debate and negotiation between members of Congress, hospitals, insurers, patient advocacy groups, physicians and air ambulance companies.

The bill also includes a package providing coronavirus economic relief and government funding for the rest of the fiscal period. Here are some highlights of the bill: Fewer surprise bills

Consumers no longer will be billed for out-of-network costs when they:

Seek emergency care — Patients who come to an out-of-network facility for a medical emergency will be covered for all care they receive until discharged or stabilized enough to be transferred to an in-network benefit level facility.

Are transported by an air ambulance.

Receive non-emergency care at an in-network hospital where they are unknowingly treated by an out-of-network physician or laboratory. Most hospital-based specialists, such as anesthesiologists, neonatologists, radiologists and surgeon’s assistants, fall into this category. Patients will still be required to pay the in network deductibles and copayments. Plus, they will need to pay the costs of any out-of-network providers they choose to see.

The legislation also doesn’t cover ground ambulance services. The Department of Health and Human Services will create a provider-patient bill dispute resolution process for those who are uninsured and for whom everything is out of network.