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New protections from surprise billing start January 1, 2022. Learn more about what we're doing, your new rights, and where you could still be vulnerable for unexpected charges.
When patients unknowingly or involuntarily seek medical care from a health care provider or facility that is out-of-network, they may receive an unexpected or “surprise” medical bill. The practice is also known as “balance billing” because patients are left responsible for the balance of bills—the difference between what the health plan covers and what the provider or facility charges. The bills can range from hundreds to thousands of dollars due, contributing to financial distress and medical debt.
There is good news for patients, though: on January 1, 2022, patients will have new protections from surprise bills, along with other new measures designed to increase transparency and lower costs.
Proper implementation, however, will be an ongoing concern as we attempt to ensure that these critical protections are adequately reaching the patients and families who need them.
What can you still expect to pay? You will still be responsible for your normal, in-network copay, coinsurance or deductible.
Who does this apply to? Most Americans are covered by these laws, except for those who are on short-term plans or in a sharing ministry rather than insurance. If you get your insurance from your employer, if you buy it on the Marketplace, even if your plan is a pre-ACA grandfathered plan… you’re covered! And if you are on Medicare or Medicaid, your plan already prohibited balance billing.
Health insurance is one of the most important decisions you can make. During open enrollment, we've put together resources to help you navigate the often confusing choices to find the best plan for you and your family.