KEY PROVISION

Surprise Medical Billing Also Addressed

Tax & Economic Provisions of 2021 Stimulus | January 2021

Congress acted to address charges by health care providers for unexpected or excessive costs typically arising from out-of-network services. These costs generally arise when individuals are in emergency situations or have no other care alternatives. The charges are often incurred without prior knowledge or consent. The costs are not covered by the patient’s health plan and result in unexpected bills that can run to thousands of dollars.

The new restrictions become effective in 2022 and prohibit individuals from being charged out-of-network rates without consent for:

  • Emergency care,
  • Air ambulance transport or
  • When receiving non-emergency care at an in-network facility by out-of-network professionals.

In addition:

  • The excess costs cannot be charged to the individual’s employer through an appeals process;
  • Out-of-network costs will be required to be resolved through an arbitration procedure that must use median in-network rates as a guideline for dispute resolution.

Guidance on these regulations will be forthcoming and will likely require health plans to be amended to conform to the provisions.