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Fewer Surprise Medical Bills Starting in 2022

A federal law protects consumers from receiving bills covering the balance of many out-of-network emergency medical services.
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Imagine having a medical emergency that requires an air ambulance. As if the need for such emergency transportation was not enough of a surprise, the air ambulance company may also be outside your health insurer’s network of preferred providers. In that case, you would likely receive a surprise medical bill—possibly for tens of thousands of dollars—as well.1,2

On January 4, 2021, the bipartisan No Surprises Act was signed into law. It will limit many types of surprise billing such as the case described above.2 Surprise medical billing, which is a type of balance billing, is a common occurrence in the American healthcare system. It occurs when healthcare providers charge the patient for the balance of an out-of-network bill that has not been paid in full by the insurance company. Although the law will not go into effect until January 1, 2022, it is poised to provide some relief to consumers who receive surprise bills, including those resulting from nearly 1 in 5 emergency department visits.1,2

The new law protects consumers from balance bills when they seek emergency care, when they are transported by an air ambulance, or when they receive nonemergency care at an in-network hospital but are unknowingly treated by an out-of-network physician or laboratory.1,2 These latter expenses can occur when, for instance, an out-of-network anesthesiologist assists in a surgery performed by an in-network surgeon at an in-network hospital.2

Notably, these changes will not just affect those who receive these surprise medical bills. A study published in September 2020 found that a law to limit surprise medical billing could reduce overall health insurance premiums by as much as 5%.2

Not all types of balance billing will disappear with the new law. When patients receive care from an out-of-network healthcare provider, those physicians will still be able to balance-bill. However, out-of-network physicians must provide an estimate of the costs and get patient consent at least 72 hours before treatment.1 For nonemergency situations that are more urgent but have less than a 72-hour turnaround, the bill requires that patients consent the day the appointment is made.1

The new federal legislation will cover most types of insurance plans, including those offered by self-insured employers.1,2 This represents a substantial difference from many of the laws protecting patients from surprise billing that have been passed in more than 30 states.1,2

Although the protections against surprise billing are a welcome change for consumers, there is one aspect of emergency care that federal lawmakers were unwilling to address: ground ambulances.1,2 Ground ambulances are much more commonly used than air ambulances and send surprise bills that are often higher than $450.1,2 But because of the wide diversity of ground ambulance providers and complex layers of state and local regulation, Congress has opted to create an advisory committee to address how best to tackle this challenge in the future.1,2


  1. Appleby J. Congress acts to spare consumers from costly surprise medical bills. National Public Radio. December 22, 2020. Accessed January 31, 2021.
  2. Miller S. Relief from surprise medical billing becomes law. SHRM Online. January 4, 2021. Accessed January 31, 2021.

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Last modified: February 24, 2021

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