Surprise Medical Bills Are Now Illegal
New federal protections for consumers against surprise medical bills have gone into effect as of January 1, 2022.
Before this year, consumers who received care from an out-of-network provider were often hit with surprise medical bills if their health insurance plan didn’t cover the entire cost. Starting January 1, 2022, the federal No Surprises Act rules protect consumers from most surprise bills.
If you have health coverage through your employer, a Health Insurance Marketplace, or an individual health insurance plan you purchase directly from an insurance company, these new rules will:
- Ban surprise bills for most emergency services, even if you get them out-of-network and without approval beforehand (prior authorization).
- Ban out-of-network cost-sharing (like out-of-network coinsurance or copayments) for most emergency and some non-emergency services. You can’t be charged more than in-network cost-sharing for these services.
- Ban out-of-network charges and balance bills for certain additional services (like anesthesiology or radiology) furnished by out-of-network providers as part of your visit to an in-network facility.
- Require that health care providers and facilities give you an easy-to-understand notice explaining the applicable billing protections and who to contact if you have concerns that a provider or facility has violated the new surprise billing protections
Even if you don’t have health coverage through your employer, a Health Insurance Marketplace, or an individual health insurance plan, you may still be protected.
- If you have coverage through Medicare, Medicare Advantage, Medicaid, Indian Health Services, VA health care, or TRICARE, you’re already protected against surprise medical bills from providers and facilities that participate in these programs.
- If you don’t have insurance or if you self-pay for care, in most cases, providers have to give you a good faith estimate of the anticipated costs before they provide non-emergency care. And if your final bill exceeds the good faith estimate by $400 or more, you can dispute the final charges.
Learn more about the No Surprises Act at CMS.gov/nosurprises, or call the Centers for Medicare & Medicaid Services’ Help Desk at 1-800-985-3059.
The Office of the Attorney General works to educate District residents about their consumer rights, responds to individual consumer complaints, and takes appropriate law enforcement actions where possible. Learn more about your rights and how to protect yourself against scams at oag.dc.gov/ConsumerProtection.