On Dec. 28, 2020, as part of its $900 billion stimulus bill, Congress passed the No Surprises Act (the act), which provides various health care consumer protections, particularly for out-of-network services. The act prohibits “surprise billing” by providers for emergency services and inadvertent out-of-network services at in-network facilities (inadvertent services). Additionally, the act, which goes into effect on Jan. 1, 2022, builds on the current administration’s health care price transparency initiatives, requiring price estimates for out-of-network services.

Balance billing occurs when a provider bills a patient the balance between the provider’s billed charges and what the patient’s insurer pays for the services. However, if a provider is in-network, or contracted with the insurer, the parties’ agreement prohibits this conduct.  For out-of-network providers, balance billing is widely used and can result in medical bankruptcy and lawsuits against patients by providers.