No Surprises Act now in effect

Today, U.S. Senator Patty Murray (D-WA), Chair of the Senate Health, Education, Labor, and Pensions (HELP) Committee, released the following statement as the ban on surprise billing she worked to pass went into effect at the start of the year.

Senator Murray said:

“For too long, countless patients have been surprised by an exorbitant bill for care they thought was covered by their insurance. That ends now. This year, the No Surprises Act is in full effect, meaning surprise billing is banned and patients across the country can get the care they need without fearing an unexpected, unaffordable bill for out-of-network care in emergencies and for providers they didn’t choose. I’m proud to have passed this bill, and pleased the Biden Administration is implementing it as intended, in a way that will protect patients without raising their premiums.

“Next, it’s important we continue to build on this progress with other steps to ensure everyone can get the care they need without worrying about the cost. That’s why I’m pushing to pass steps to close the coverage gap, extend health care tax credits, expand Medicare coverage, let Medicare negotiate lower drug prices, and cap monthly insulin costs at $35. It’s also why I continue to work with Chair Pallone on legislation to help us move toward universal coverage by creating a federal public option available to everyone.”

Senator Murray worked with her colleagues to draft and pass the No Surprises Act. The legislation prohibits surprise billing as of January 1, 2022 and establishes a fair payment dispute resolution process that protects patients from unexpected costs. To accomplish this, the No Surprises Act:

  • Holds patients harmless from surprise medical bills, including from air ambulance providers, by ensuring they are only responsible for their in-network cost-sharing amounts, including deductibles, in both emergency situations and certain non-emergency situations where patients do not have the ability to choose an in-network provider.
  • Prohibits certain out-of-network providers from balance billing patients unless the provider gives the patient notice of their network status and an estimate of charges 72 hours prior to receiving out-of-network services and the patient provides consent to receive out-of-network care (or on the day the appointment is made if services are scheduled within less than 72 hours).
  • Creates a framework that takes patients out of the middle, and allows health care providers and insurers to resolve payment disputes without involving the patient.
  • Insurers must make a payment to the provider that is determined either through negotiation between the parties or an independent dispute resolution (IDR) process. There is no minimum payment threshold to enter IDR, and claims may be batched together to ease administrative burdens.
  • If the parties choose to utilize the IDR process, both parties would each submit an offer to the independent arbiter.
  • Following an IDR process, the party that initiated the dispute may not take the same party to arbitration for the same item or service for 90-days following a determination by the arbitrator. However, all claims that occur during the 90-day period are eligible for IDR after the 90-days.
  • Provides additional consumer protections when insurance companies change networks, including a transition of care for people with complex are needs and appeal rights for consumers.
  • Empowers consumers by providing a true and honest cost estimate that describes which providers will deliver their treatment, the cost of services, and provider network status.

Legislation has been introduced in Washington State to align state law with the No Surprises Act. Read more coverage about that here.