What Is The “No Surprise Act?”

Even those who read the fine print can be surprised by some of the costs associated with unexpected visits to the emergency room. And we don’t mean an “out-of-network” ER. We mean an “in-network” ER or doctor’s office, neither of which will necessarily tell you upfront about the various “out-of-network” costs associated with care you thought was completely covered. The “No Surprise Act” bans such charges outright.

The new law went into effect on the first of January after Congress approved it late last year. 

Assistant Director Loren Adler of the USC-Brookings Schaeffer Initiative for Health Policy said, “The No Surprises Act is really one of the biggest consumer protections to pass in recent decades. Now when patients go to the hospital for an emergency or for elective planned care, like a surgery, they no longer have to worry about getting a surprise out-of-network bill.”

The American Heart Association and American Medical Association (among others) have already filed litigation in opposition to the new consumer-driven law. 

According to the Kaiser Family Foundation, 20 percent of ER visits result in a surprise bill. About one in six hospitalizations result in the same. These normally result in charges for anesthesia, surgical assistant fees, etc — everything you would think should be covered on normal health insurance when you’re in your network.

Health and Human Services (HHS) Secretary Xavier Becerra said, “No one should have to worry about going bankrupt after falling ill or seeking critical care.”

Patients are still allowed to see out-of-network providers as well, but there are new protections. The provider cannot bill patients without first making clear they are not inside the patient’s network. The provider must also provide estimates of what the care will ultimately cost. 

President Gerald Harmon of the AMA said, “Our legal challenge urges regulators to ensure there is a fair and meaningful process to resolve disputes between health care providers and insurance companies. But if regulators don’t follow the letter of the law, patient access to care could be jeopardized as ongoing health plan manipulation creates an unsustainable situation for physicians.”