January 06, 2021
The No Surprise Act ("Act"), part of the stimulus bill, was signed into law on December 28. The Act applies to the 135 million Americans with self-funded coverage, as well as those in fully-insured plans. Patients are the major beneficiaries of the Act. It extends them balance billing protection when they utilize federally regulated providers including Air Ambulance services, but not ground ambulances. Patients will be responsible for only the cost-sharing amounts that they would pay to in-network providers in either an emergency or nonemergency setting when they utilize an out-of-network provider.
The impact on providers and payors is yet to be determined, as providers will be paid on the amount they negotiate or an amount determined in binding arbitration. The law goes into effect on January 1, 2022.
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