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No Surprises Act: How it impacts Utahns

Posted at 10:00 AM, Jan 21, 2022
and last updated 2022-01-21 20:03:14-05

Surprise billing is common among people covered by private insurance.

As many as 1 in 5 emergency room visits and 1 in 6 in-network hospitalizations can include at least one out-of-network bill, often called surprise medical bills.

Stephen Foxley with Regence BlueCross BlueShield of Utah says, "Sometimes it could be a few hundred dollars, sometimes it could be a few thousand dollars and those would be unexpected costs."

Unexpected or surprise bills happen when a medical professional provides patient care but is not covered by the patient's health plan.

For example, when a patient breaks a leg and just needs to get to the nearest emergency room. Or, when a patient has surgery in a hospital in their network, but the anesthesiologist isn't part of it.

Surprise bills can cause financial hardships, even bankruptcies.

Last year, federal government acted and passed the No Surprises Act. It went into effect on January 1, 2022.

Foxley says now, "The insurance company and those providers have worked out a negotiated price. It's a known price and it's going to be a better deal."

The federal ban protects patients in situations where they cannot choose their care provider.

But, that doesn't mean that patients don't have to do their homework to find a doctor, specialist or hospital in your network, especially if it's for routine care.

"The No Surprises Act would not apply if you choose to see an out-of-network provider when it's not an emergency, it only works when you don't have a say in the provider you see," says Foxley.

Because this law is so new, it will take time for the health care system to fully adopt it.

Patients with complaints about an unexpected medical bill can call 1-800-985-3059 or visit cms.gov/nosurprises.