As of January 1, 2022, when getting emergency care, non-emergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers, consumers now have new billing protections. Through these new rules which have been instituted to protect consumers, excessive out-of-pocket costs are now restricted, and emergency services must continue to be covered without any prior authorization, and regardless of whether or not a provider or facility is in-network.

Prior to this new Act, if consumers having health coverage received care from an out-of-network provider, their health plan typically would not cover the entire out-of-network cost and as a result, left many consumers with higher costs than if they had been seen by an in-network provider. This is especially common in emergency situations where insured consumers might not be able to choose the provider due to the urgency of the situation. Even if a consumer goes to an in-network hospital, they might get care from out-of-network providers at that facility.

In many cases, the out-of-network provider could bill consumers for the difference between the charges the provider billed, and the amount paid by the consumer’s health plan; this is known as balance billing. This unexpected balance billing is commonly known as a surprise billing. Many of us who are also insured consumers, if not all of us, have dealt with this very same issue at least once.

The Consolidated Appropriations Act of 2021 was enacted on December 27, 2020 and contains many provisions to help protect consumers from surprise bills, including the No Surprises Act under title I and Transparency under title II. Learn more about protections for consumers, understanding costs in advance to avoid surprise bills, and what happens when payment disagreements arise after receiving medical care.