Medical billing can be confusing and overwhelming for patients, especially when they receive unexpected or surprise medical bills. These surprise bills, also known as balance billing, occur when a patient receives a bill from a healthcare provider for the difference between the provider's charges and what the patient's insurance plan pays.
To protect patients from surprise medical billing, Congress passed the No Surprises Act as part of the Consolidated Appropriations Act of 2021. This act aims to provide transparency and fairness in medical billing by limiting the amount that patients have to pay for out-of-network services and ensuring that patients are only responsible for in-network cost-sharing amounts.
Under the No Surprises Act, patients are only responsible for paying their in-network cost-sharing amount, which is the amount that they would normally pay for in-network services. This includes copays, deductibles, and coinsurance. Out-of-network providers can only bill the patient for the in-network cost-sharing amount, and any additional charges must be resolved between the provider and the insurer.
The No Surprises Act also requires that patients receive clear and concise information about their out-of-network benefits and any potential balance billing before receiving care. This includes a written estimate of the costs of the services, as well as notification if the provider is out-of-network.
In addition to protecting patients from surprise medical billing, the No Surprises Act also aims to reduce healthcare costs by promoting the use of in-network providers. By incentivizing providers to join networks, the act aims to increase competition and drive down costs for both patients and insurers.
Overall, the No Surprises Act is a major step towards transparent and fair medical billing practices. It helps to protect patients from unexpected medical bills and promotes the use of in-network providers, which can help to lower healthcare costs. If you have any questions about your medical bills, be sure to reach out to your healthcare provider or insurer for more information.