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No Surprises Act Tackles Unexpected Medical Bills at the Federal Level

The new federal law on health care costs aims to provide comprehensive guidance on surprise medical bills received by consumers while states consider and enact their own laws.

01/04/2022 2:15 P.M.

2 minute read

New consumer protections for medical bills are in effect through the No Surprises Act, which hit the roster of federal laws addressing health care costs on Jan. 1.

In addition to banning surprise billing for emergency services, it also bans certain non-emergency care provided by out-of-network providers at in-network facilities and limits high out-of-network cost-sharing, ACA International’s Vice President of State Unit and Government Affairs Andrew Madden and Communications Director Anne Rosso May report in the latest issue of Collector magazine.

Nearly a dozen states considered legislation to address medical debt collection in 2021, with four ultimately enacting laws. The No Surprises Act is the first comprehensive legislation at the federal level to address surprise medical bills, Money.com reports.

“Through new rules aimed to protect consumers, excessive out-of-pocket costs will be restricted, and emergency services must continue to be covered without any prior authorization, and regardless of whether or not a provider or facility is in-network,” according to the U.S. Centers for Medicare and Medicaid Services.

The Biden administration issued an interim final rule last year to further implement the No Surprises Act. It provides a transparent process to settle out-of-network rates between providers and payers, take patients out of the middle of payment disputes, and cover requirements for health care cost estimates for uninsured self-pay patients.

Consumers may have questions on what to do if they receive a surprise medical bill when in contact with third-party debt collectors that work on behalf of health care providers.

The new law requires providers to send the out-of-network bill to the consumer’s health insurance plan first, according to Money.com, and the health plan will inform the doctor or hospital about any in-network cost sharing that will apply to the claim.

Then, the bill from the out-of-network provider can be sent to the consumer.

Should ACA members get questions from consumers or their health care provider clients about managing debts, the new Know My Debt website is a great resource.

Many ACA members are using the new Know My Debt consumer education site to enhance the ways they serve consumers and, ultimately, clients, ACA previously reported.

Developed by ACA’s Financial Literacy Committee, Know My Debt delivers clearly worded explanations to help consumers improve their financial literacy and resolve their debts.

For more information on the No Surprises Act and state medical debt collection laws, read Madden’s Collector magazine article here.

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