What protections do you have from surprise medical bills?

Americans with health insurance now have new protections against unfair surprise medical bills.

On January 1, 2022, the No Surprises Act went into effect, banning practices that had previously led as many as 1 in 5 Americans who visited a hospital or emergency room to receive surprise charges costing them hundreds, or even thousands, of dollars.

But what exactly is in this new law, and what does it mean for you? Here are some tips to help you get to know your new protections.

First, we could use some definitions: What exactly is a surprise medical bill?

Oftentimes, people choose to go to hospitals and see health care providers that are in their insurance network. The thing is, it’s often very difficult for people to be 100% sure that they’re only treated by in-network providers, and most patients can’t know for sure until they get home.

If even one of the health care providers they visit isn’t in-network, then they will still receive a bill charging them for the out-of-network service. These so-called “balance bills” then show patients the difference between what their insurance covers and what they have to pay for themselves.

So how does the No Surprises Act protect me?

The new law protects you from out-of-network charges you might receive from an emergency room, an in-network health care facility, or from being transported by an air ambulance (via airplane or helicopter).

Additionally, your health plan now has to provide you with a document, called an Explanation of Benefits (or EOB), that details the cost of in-network service. To protect yourself, you should always compare your medical bills to your EOB.

There’s an important exception here though: Protections from the No Surprises Act are not extended to out-of-network ground ambulance rides.

And there’s another caveat: These protections DO NOT apply to all types of medical facilities.

You will be protected from surprise bills when visiting hospitals, hospital outpatient departments and ambulatory surgery centers that participate in your plan's network. However, you WILL NOT receive these protections in other types of health care facilities, including birthing centers, clinics, hospice, addiction treatment facilities, nursing homes or urgent care centers.

If you’re scheduling a visit to any of these other facilities, be sure to ask before treatment if the facility and its providers are part of your health plan's covered network.

Anything else I should know?

If you’re scheduling treatment ahead of time, some out-of-network physicians might ask you to sign a document (called the Surprise Billing Protection Form) that would commit you to paying their out-of-network charges. We recommend that you don’t sign this form; ask for an in-network provider instead.

If you think you’ve received a surprise medical bill, reach out as soon as possible to your insurance and your provider.

If you want more information, you can check out this helpful guide from our friends at U.S. PIRG. Read up to make sure you and your family can avoid these unfair bills.