When President Donald Trump signed into law the
Continuing Appropriations Act, 2021, shortly before the end of 2020, it included a revised version of the bipartisan
No Surprises Act, with long-sought curbs on unscheduled "surprise" out-of-network health care charges. These expenses often result when care is received at an out-of-network emergency room, or for ancillary services, such as when, without the patient's knowledge,
an out-of-network anesthesiologist assists in a surgery performed by an in-network surgeon at an in-network hospital.
The limits on surprise billing by doctors and hospitals, and so-called balance billing in which health care providers charge plan enrollees for the balance of an out-of-network bill when an insurance company won't pay the full amount, should reduce unplanned costs for plan enrollees and help self-insured employers, especially, to manage their health care spending. Fully insured employees could see some moderation in premium increases. A study published last September in the
American Journal of Managed Care found that a comprehensive federal law to rein in surprise medical billing
could reduce overall health insurance premiums by 1 percent to 5 percent.
The new law "holds patients harmless from surprise bills, including from air ambulance providers, and prohibits out-of-network providers from balance billing unless they give patients 72-hour notice of their network status and an estimate of the charges," said Chatrane Birbal, vice president for public policy at the Society for Human Resource Management.
Consumers and employers, however, did not get everything they had sought in the final legislation, which could lessen the expected cost savings they had hoped to see.
What the Law Changes
Most of the new requirements take effect with plan years
beginning Jan. 1, 2022. Among the provisions affecting employer-sponsored group plans, including self-insured plans, are the following:
