Surprise Billing: An Overview of the Federal No Surprises Act and Its Interaction with Illinois’ LawUpdated June 2022
In December 2020, Congress passed and then-President Donald Trump signed the No Surprises Act (NSA), which was part of the Consolidated Appropriations Act of 2021. The provisions in the NSA were intended to protect patients from unexpected medical bills incurred as a result of potentially confusing in-network/out-of-network relationships between physicians, health care facilities, and insurance plans. Specifically, the NSA was enacted to prevent patients from receiving “surprise bills” for services received from physicians or other health care professionals who are not part of the patient's insurance plan provider network. Many of the provisions of the NSA became effective January 1, 2022.
The NSA is a federal law, and protects most patients with private health insurance. It applies to patients who are insured through employer-sponsored group health plans (those generally regulated by ERISA are exempt from state-level insurance regulations) and individual plans purchased through the health insurance exchanges or on the individual market. The Act does not apply to Medicare and Medicaid, which already have protections against surprise billing.
What Physicians Need to Do Now
DON'T bill insured patients if you provide care as an out-of-network physician at an innetwork health care facility, and do not collect cost-sharing amounts from the patient that are more than the in-network amount. Physicians must have prior written consent from the patient to receive out-of-network services and be balance billed in order to collect additional payments directly from patients.
To view this Issue Brief in its entirety, please log in.