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Spotlight mandate: Consolidated Appropriations Act—including No Surprise Billing Legislation Part One

Middle aged older woman housewife reading paper letter or bill sitting in kitchen at home office, checking financial taxes fees, reviewing bank account loan rates information, medical insurance cost.

These regulations intend to protect members from certain unexpected bills, or “balance bills,” for out-of-network emergency services, care by out-of-network providers at an in-network facility, and out-of-network air ambulance service. A “balance bill” is the difference between what your health plan agreed to pay for a service and the full amount charged for a service.

Prior to the No Surprises Act, if you received services from an out-of-network provider, the provider was usually permitted to bill you this additional amount. Most likely, the additional amount did not count toward your annual out-of-pocket maximum. The No Surprises Act protects members from having to make certain additional payments by prohibiting balance billing for out-of-network emergency services, care by out-of-network providers at an in-network facility and out-of-network air ambulance services.