Law aiming to protect consumers against surprise medical bills takes effect : NPR

Adrian Florido speaks with Kaiser Overall health News reporter Julie Appleby about the No Surprises Act, which went into effect on Jan.1.


Sudden healthcare charges from out-of-community providers have been an all much too common fact for quite a few Us citizens. Usually they appear after a visit to a medical center crisis space. But a new federal law that went into result yesterday is intended to defend clients from these types of unwanted surprises. The legislation, accepted by Congress extra than a year ago, is known as the No Surprises Act.

To support us superior realize what this legislation indicates for patients, we have termed Julie Appleby. She’s a reporter with Kaiser Health News, and she joins us now. Julie Appleby, welcome to the program.

JULIE APPLEBY: Many thanks for having me.

FLORIDO: Why did Congress tackle this challenge? How large of a dilemma have these unexpected healthcare costs been for sufferers?

APPLEBY: You know, these have been a large dilemma. Men and women have been complaining about this for a while. In actuality, some experiments right before this legislation passed confirmed that 1 in 5 emergency area visits and about 1 in 10 elective surgical procedures resulted in one particular of these surprise out-of-network charges. So they were listening to about it from their constituents for a when, and people today had been complaining to their companies. But it still took a extensive time to sort this out. I suggest, Congress was debating this for about two many years. It just about handed one yr and then at the incredibly past moment unsuccessful. And then at the very end of December 2020, it passed. And it was signed into legislation by then-President Donald Trump, and the Biden administration has spent the last calendar year crafting the procedures that’ll variety of govern how this thing in fact operates.

FLORIDO: And so how will it work? What does this regulation suggest for individuals who may possibly have to go to unexpected emergency rooms, for case in point?

APPLEBY: Nicely, underneath the legislation, fundamentally, the patient is taken out of the center of these disputes. So the client is only likely to shell out the deductible and the co-payments that they would have experienced, experienced their care been in-network. Then the legislation suggests insurers and the healthcare suppliers have to get the job done it out involving them selves, what the genuine amounts paid out will be. So if they are not able to concur, the regulation suggests the two sides have to go to an arbitrator and each individual of them place up their very best provide. And then the arbitrator is heading to choose one particular of all those, and that is what the insurer will pay out. This legislation is going to implement broadly to key professional medical insurance coverage and options sold to individuals by way of the Very affordable Treatment Act. Before procedures stated that surprise billing was currently banned below Medicare and Medicaid.

FLORIDO: It could even now be the situation, however – proper? – that a patient receives an unanticipated huge professional medical monthly bill for an crisis. What does this invoice not protect patients from?

APPLEBY: So the legislation isn’t going to consist of floor ambulances, for case in point. And some studies have discovered that at the very least half of all floor ambulance rides may end result in a shock monthly bill. So it can be very feasible that if you’re taken to the hospital in ambulance, you may possibly get a stability invoice. It truly is not retroactive.


APPLEBY: So if you incurred any of this in 2021, you could still be on the hook for these payments. The law also does not utilize to nonemergency providers supplied in other facilities, factors like dependancy treatment method centers and nonemergency mental health counseling. So it is really feasible persons may get a shock bill there. And then urgent treatment facilities are type of an fascinating gray spot that we’re going to have to look at since the regulations governing how this regulation will work say that the protections implement to urgent care clinics that are licensed to present unexpected emergency expert services. But lots of urgent treatment amenities are not certified especially for emergency expert services. So variety of the base line – it remains a good plan for customers to test very first in form of nonemergency circumstances that the facility or the service provider they’re selecting is in network. For emergencies, you can experience a lot extra self-assured that this regulation will deal with you.

FLORIDO: What need to persons do in the new 12 months if they get a massive invoice that they assume could possibly run afoul of this regulation?

APPLEBY: Yeah, completely. If they get a monthly bill that they assume does operate afoul of the law, they should call their insurance coverage plan and appeal and say, hey, I imagine that I am getting unfairly billed in this article. They should really speak to the man or woman who sent it to them, the similar factor, and increase that issue due to the fact they do have these protections now.

FLORIDO: That was reporter Julie Appleby of Kaiser Health and fitness Information. Julie, thanks for being with us now.

APPLEBY: You’re welcome.


Copyright © 2022 NPR. All legal rights reserved. Pay a visit to our site conditions of use and permissions pages at for further information.

NPR transcripts are developed on a hurry deadline by Verb8tm, Inc., an NPR contractor, and manufactured applying a proprietary transcription course of action designed with NPR. This textual content may possibly not be in its last kind and could be updated or revised in the long run. Precision and availability may change. The authoritative file of NPR’s programming is the audio document.