Under the law, effective upon plan years beginning on or after January 1 2022, out-of-network providers are prohibited from pursuing members directly for balance medical bills in situations where they have little or no control over who provides their care, like for all emergency services (except ground ambulance), or when an out-of-network provider is involved in their care while they are at an in-network facility.

If a patient receives a service that is covered by the No Surprises Act, the law adjusts the patient’s cost share to roughly what it would be if the services were provided in-network.

Patients are protected from balance bills when they receive:

• Out-of-network emergency services, including air ambulance (but not ground ambulance)
• Covered medical items and services performed by an OON provider at an INN facility (unless non-ancillary services and the provider follows the notice and consent process ).
• Out-of-network non-emergency, ancillary services* provided at in-network facility.
• Non-emergency, non-ancillary services provided at in-network facility, and the provider did not get your prior consent in the way the No Surprises act requires.

And, for the above services, your cost-share (in other words, your coinsurance, copay, deductible):

• Is roughly the same as it would have been if the service was provided in-network.
• Counts toward your in-network deductible.
• Counts toward your out-of-pocket maximum.

*Ancillary services include services related to emergency medicine, anesthesiology, pathology, radiology and neonatology; certain diagnostic services (including radiology and laboratory services); items and services provided by other specialty practitioners; and items and services provided by an out-of-network provider if there is no in-network provider that can provide that service.

You can find an explanation of what out-of-network laws are currently in place in your state here.

The law may not pre-empt state balance billing laws that establish a process for determining OON reimbursement for covered items and services for insurers subject to the state’s law.

The No Surprises Act is effective for plan years when they commence on or after January 1, 2022.  Therefore, if a plan renews during 2022, the No Surprises Act will go into effect on that plan's renewal date.

For example, if a plan year commences on December 1, 2022, the No Surprises Act will go into effect for that plan on that plan's renewal date.

Insurer and health plans: provisions applicable to insurers and health plans are enforced by the applicable federal agency (the Departments of Health and Human Services, Labor, and the Treasury).

Providers and facilities: provisions applicable to health care providers and facilities are enforced by the Department of Health and Human Services which may impose fines of up to $10,000 per violation.

States: provisions applicable to providers and facilities (including air ambulance) may be enforced by the states.