On Jan. 1, a new law will go into effect limiting “surprise” medical bills, or bills patients receive for out-of-network care, in emergency settings and from out-of-network providers at in-network facilities. The No Surprises Act, enacted in December 2020, is part of the 2020 year-end omnibus spending bill known as the Consolidated Appropriations Act of 2021.
What Is Surprise Billing?
Most group health plans and health insurance issuers that offer group or individual health insurance coverage have a network of providers and health care facilities (in-network providers) that agree to accept a specific payment amount for their services. Providers and facilities that are not part of a plan or network (out-of-network or OON providers) usually charge higher amounts than the contracted rates the plans or issuers pay to in-network providers.
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