Ban on surprise medical bills gets underway in ’22

Legislation will cover almost all emergency services and most routine care

For years, millions of Americans with medical emergencies could receive another nasty surprise: a bill from a doctor they did not choose and who did not accept their insurance. A law that goes into effect Saturday will make many such bills illegal.

The change is the result of bipartisan legislation passed during the Trump administration and fine-tuned by the Biden administration. It is a major new consumer protection, covering nearly all emergency medical services, and most routine care.

“I think this is so pro-consumer, it’s so pro-patient — and its effect will eventually be felt by literally everybody who interacts with a health care system,” said Sen. Bill Cassidy, R-La., who was part of a bipartisan group of lawmakers who wrote the bill. He said he counted the bill as among his top achievements as a lawmaker.

Even with insurance, emergency medical care can still be expensive, and patients with high-deductible plans could still face large medical bills. But the law will eliminate the risk that an out-of-network doctor or hospital will send an extra bill. Those bills add up to billions in costs for consumers each year.

Behind the scenes, medical providers are still fighting with regulators over how they will be paid when they provide out-of-network care. But those disputes will not interfere with the law’s key consumer protections.

In the case of a medical emergency that requires a visit an urgent care center or emergency room, patients can’t be charged more than the cost sharing they are accustomed to for in-network services. This is where the law’s protections are the simplest and the most clear for people with health insurance.

People will still be responsible for things like a deductible or a copayment. But once patients make that normal payment, they should expect no more bills.

Several studies found that around 20% of U.S. patients who had emergency care were treated by someone outside their insurance network, including emergency room doctors, radiologists or laboratories. Any of those providers could send patients an extra bill after the fact, and some medical groups did so routinely. Such bills are now illegal.

There is one important exception. The new law does not prevent ambulance companies from billing you directly for their services if they travel on roads. It does offer protections against surprise bills from air ambulances.

Ground ambulances were left out of the recent legislation because legislators determined they would need a different regulatory approach. Congress established a commission to study the issue and may consider reforms.

Eleven states prevent ambulances from sending out-of-network medical bills. Patients who live in the other states are quite likely to get a bill in the mail if they require an ambulance. Research shows as many as half of people who need an ambulance receive such a bill, though the amount is not always large.