LITTLE ROCK – As of January 1, 2022, consumers have new billing protections when getting emergency care, non-emergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers. Through new rules aimed to protect consumers, excessive out-of-pocket costs will be restricted, and emergency services must continue to be covered without any prior authorization, regardless of whether or not a provider or facility is in-network.
Prior to the No Surprises Act, if consumers had health coverage and received care from an out-of-network provider, their health plan usually would not cover the entire out-of-network cost. This may have left them with higher costs than if they had been seen by an in-network provider. This is especially common in emergency situations, where consumers may not be able to choose the provider. Even if a consumer goes to an in-network hospital, they may receive care from out-of-network providers at that facility.
In many cases, the out-of-network provider could bill consumers for the difference between the charges the provider billed and the amount paid by the consumer’s health plan. This is known as balance billing. An unexpected balance bill is called a surprise bill.
“The No Surprises Act is an important consumer protection tool that will help to prevent unexpected medical bills that may otherwise be financially devastating for Arkansas families,” said Arkansas Insurance Commissioner Alan McClain. “Arkansans should be able to focus on recovery after a medical emergency, not worry about paying a surprise bill.”
Commissioner McClain encourages Arkansans to learn about the new consumer protection measure.
What protections are in place?
The No Surprises Act, protects you from:
- Surprise bills for covered emergency out-of-network services, including air ambulance services (but not ground ambulance services), and
- Surprise bills for covered non-emergency services at an in-network facility.
The law applies to health insurance plans starting in 2022. It applies to the self-insured health plans that employers offer as well as plans from health insurance companies.
- A facility (such as a hospital or freestanding emergency room [ER]) or a provider 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.
- If your health plan requires you to pay copays, coinsurance, and/or deductibles for in-network care, you are responsible for those.
- The new law also protects you when you receive non-emergency services from out-of-network providers 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.
- You can never be asked to waive your protections and agree to pay more for out-of-network care at an in-network facility for care related to emergency medicine, anesthesiology, pathology, radiology, or neonatology—or for services provided by assistant surgeons, hospitalists, and intensivists, or for diagnostic services including radiology and lab services.
- You can agree in advance to be treated by an out-of-network provider in some situations, such as when you choose an out-of-network surgeon knowing the cost will be higher. The provider must provide information in advance about what your share of the costs will be. In doing this, you will be expected to pay the balance bill, as well as your out-of-network coinsurance, deductibles, and copays.
What else should I know?
- Your health plan and the facilities and providers that serve you must send you a notice of your rights under the new law.
- If you have received a surprise bill that you think is not allowed under the new law, you can file an appeal with your insurance company or ask for an external review of the company’s decision. You also can file a complaint with the Arkansas Insurance Department (AID) or the federal Department of Health and Human Services.
- An independent dispute resolution (IDR) process, or another process your state sets up, is available to settle bills. Providers and insurance companies can use this process to settle disputes about your bill without putting you in the middle. A similar dispute resolution process is available for individuals who are uninsured, in certain circumstances, such as when the actual charges are much higher than the estimated charges.
- Other protections in the new law require insurance companies to keep their provider directories updated. They also must limit your copays, coinsurance, or deductibles to in-network amounts if you rely on inaccurate information in a provider directory.