Deirdre Cummings
Legislative Director, MASSPIRG
617-747-4319
[email protected]
New consumer protections curbing “Surprise Medical Bills” start Jan. 1
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MASSPIRG
BOSTON — Americans with health insurance will have a new suite of rights when the No Surprises Act goes into effect on Jan.1, 2022. This landmark law designed to protect patients from unfair and exorbitant medical charges will ban most “surprise bills” and keep consumers out of the middle of payment disputes. Because the new law has provisions that may be confusing to laypeople, MASSPIRG has released a consumer tips guide to help patients understand their rights.
One in 5 Americans who visits an emergency room or has surgery receives a surprise medical bill from an out-of-network provider. Often, patients don’t know in real time that the provider who treats them is out-of-network. Then, surprise! They’re at home, recovering, and receive a bill for hundreds or even thousands of dollars. These “balance bills” ask for the difference between what the medical provider charges and the patient’s insurance company is obligated to pay. Massachusetts has some protections in place, however the new law will adds additional protections.
“Even when patients do everything right in advance to minimize out-of-pocket costs, unbeknownst to them, an out-of-network provider such as an anesthetist may insert themself into the procedure,” said Deirdre Cummings, Legisltive Director, MASSPIRG. “It’s not like anyone imagines getting surgery without anesthesia. But whether you signed off on their involvement or not, those out-of-network providers were sending you a bill, and for a lot more than the same service by someone covered by your health plan.”
The No Surprises Act prohibits out-of-network providers from sending surprise bills to patients seeking emergency room care, air ambulance services or non-emergency care at in-network hospitals. A recent brief by the U.S. Department of Health and Human Services (HHS) showed that the average surprise bills for anesthesia are more than $1,200 and for childbirth are more than $750.
“Insured Americans will finally be able to focus on getting the care they need without wondering if they’ll be hit with an outrageous out-of-network bill from a provider they didn’t choose,” said Cummings. “Once the No Surprises Act goes into effect, the best way to protect ourselves from illegal charges will be to know our rights.”
MASSPIRG released a tip sheet today that insured Americans can use as a handy reference guide to those new rights. The tips explain which bills are illegal and what to do if they get one. It also includes the phone number for a Department of Health and Human Services (HHS) hotline that will be up and running on Jan. 1 to answer patients’ questions and take complaints about doctors and hospitals who might be on the wrong side of the law.
Some medical providers are actively fighting the implementation of the new law. The American Hospital Association (AHA) and the American Medical Association (AMA) have filed a lawsuit against the federal government to prevent some parts of the law from going into effect. Earlier this month, U.S.PIRG filed comments in support of the rules the AMA and AHA are fighting.
“We have an opportunity to ring in the New Year with a new era of fair medical bills for Americans,” said Kelmar. “It’s unconscionable that physicians whose primary purpose is to do no harm are fighting against rules that would protect the patients who they treat.”
U.S. PIRG was instrumental in passing several state laws that led to the No Surprises Act and was active in the 2019 Congressional battle against private-equity backed opponents of the federal bill. Since then, the nonprofit advocacy group has been educating consumers about their rights; the tip guide is part of this effort.
HHS has launched a website for additional information about the new law at https://www.cms.gov/nosurprises
