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A new federal law that AARP advocated for is now in effect that protects consumers against so-called “surprise” medical bills and “balance billing.”

The “No Surprises Act” which took effect Jan. 1, 2022, should help limit excessive out of pocket costs for health care consumers from surprise billing and balance billing practices.

Surprise billing happens when a patient receives an unexpected balance bill after they receive care from an out-of-network provider or at an out-of-network facility, such as a hospital. It can happen for both emergency and non-emergency care. Typically, patients don’t know the provider or facility is out-of-network until they receive the bill.

Balance billing happens when a health care provider bills a patient after the patient’s health insurance company has paid its share of the bill for out-of-network care. The balance bill is for the difference between the provider’s charge and the price the insurance company set, after the patient has paid any copays, coinsurance, or deductibles. This practice is prohibited in both Medicare and Medicaid. However, in some states, including Montana, it was allowed through employer-sponsored and commercial health care plans.

So this meant that in some Montana hospitals, after patients paid their required co-pays or deductibles and after their health insurance coverage paid the hospital, they could still get a hefty bill from the hospital for the amount that the health care coverage did not pay. These balance billings were almost always a major surprise or shock to Montana consumers. It’s important to note that not all Montana hospitals practiced balance billing.

The No Surprises Act protects you from:

n Surprise bills for covered emergency out-of-network services, including air ambulance services (but not ground ambulance services).

n Surprise bills for covered non-emergency services at an in-network facility. The law applies to fully insured plans offering group or individual health insurance coverage and self-insured group health plans.

n A facility may not bill you more than your in-network coinsurance, copays, or deductibles for emergency services, even if the facility or provider is out-of- network, without your advance knowledge and consent.

n If your health plan requires you to pay copays, coinsurance, and/or deductibles for in-network care, you’re responsible for those.

n The new law also protects you when you receive non-emergency services from out-of-network providers (such as an anesthesiologist) at in-network facilities. An out-of-network provider may not bill you more than your in-network copays, coinsurance, or deductibles for covered services performed at an in-network facility, without your advance knowledge and consent.

The No Surprises Act is a major step toward ending unexpected medical bills that may otherwise be financially devastating for Montana families. We applaud this new law that limits surprise medical billing and balance billing practices and strongly urge Montana consumers to take a very close look at their medical bills to make sure that they aren’t paying more than they need to.

The Commissioner of Securities and Insurance is the primary enforcer of the No Surprises Act in Montana. Consumers can file a complaint online at https://csimt.gov or call (800) 332-6148 or (406) 444-2040 to speak with a policyholder services staff member.

For more information about the No Surprises Act visit: www.cms.gov/nosurprises

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Mike Batista is the director of government affairs for AARP Montana.

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