The end of an era of nasty surprises for consumers of emergency medical care, and of surprise medical bills, is at hand. The terms “surprise medical bill” or “balance bill” describe charges arising when an insured patient receives care from an out-of-network provider. 
When I last surveyed the state of play in all fifty states in my article entitled Review of the States’ Surprise Billing Laws and Efforts to Find an End to Surprise Billing in New York and on the Federal Level, published in The FORC Summer Journal, August 2020, I noted that in 2017, researchers had found more than half the states did not have any laws in place protecting consumers from balance billing and only six states had comprehensive balance billing statutes. 18 months later, in February 2020, at the cusp of our national COVID-19 nightmare, the experts at the Georgetown University Center for Health Insurance Reform (CHIR) found that just nine states had comprehensive consumer protection laws against surprise billing: NY, CA, OR, FL, IL, NJ, VT, DE and CT.
Moreover, four states—Arizona, Maine, Minnesota and Oregon—had adopted their first-ever balance billing laws during the 2018 session.
Until recently, no Federal law currently limited “balance bills” or “surprise bills” but just over half the states had enacted laws to protect enrollees from them, to some degree.
Now, thanks to a new Federal bill, officially medical providers will be prohibited from charging out-of-network rates for emergency and ancillary services, such as anesthesiology, delivered during scheduled procedures at in-network facilities.
In the final days of the 116th Congress, legislation was passed containing COVID-19 relief and fiscal year 2021 government funding. The bill, officially titled as a bill “To amend title XXVII of the Public Health Service Act to protect health care consumers from surprise billing practices, and for other purposes” (hereafter referred to as the “No Surprises Act” or the Act”), is scheduled to take effect in 2022. The Act provides new guidelines for private insurers. The No Surprises Act was the result of months-long negotiations between House and Senate leadership. While 32 states already have legislation that deals with surprise billing practices, the new federal provisions apply to markets not controlled by the states. How states will be impacted continues to be evaluated.
Under the Act, health plans will be required to hold patients harmless from surprise medical bills, and patients will be required to pay only the “in network cost-sharing for out-of-network emergency care or certain services performed by out-of-network providers at in-network facilities. A patient’s in-network payments for out-of-network surprise bills will go toward the patient’s in-network deductible. Examples of cost-sharing can include copayments, coinsurance and deductibles.
Although more than two dozen states have passed laws to regulate surprise medical billing, they exclude self-funded insurance plans favored by large employers.