The Biden Administration has asked for input in clarifying how the law banning surprise medical billing would address non-emergency care from out-of-network providers. Should a specialist be allowed to refuse to treat someone unless he/she can balance bill the individual without putting pressure on the patient to waive their protections? The law implements a “notice and consent” process which must be in-acted when a provider wishes to balance bill an individual seeking treatment. How to accomplish this without undermining the insurance network model, which purportedly holds down costs, is at question.

The No Surprise Act (NSA) was part of the COVID-19 relief package voted into law by Congress last December. Going into effect in January of 2022, the NSA prohibits providers from billing patients more than in-network cost-sharing. It applies to situations where patients cannot choose in-network providers like emergency care and certain nonurgent circumstances where a network provider is not available.

The law also holds providers responsible for keeping provider directories up to date and accessible to their members. If a patient can show that they received outdated information on whether a provider was in-network prior to an appointment, they will have to pay the in-network cost-sharing amount only.

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