ST. GEORGE — A new federal law, which took effect on New Year’s Day, the No Surprises Act, expands protections already in place in Utah and across the U.S. to prevent surprise medical billing.
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The new regulation protects people covered under health plans from “balance billing,” or receiving unexpected medical bills from emergency or non-emergency services provided by physicians who are not in their insurance network.
Stacy Stanford, analyst for the Utah Health Policy Project, said the new law takes a lot of stress out of the health care process for consumers.
“These surprise bills really weigh on people’s minds,” Stanford observed. “There’s a lot of affordability fears out there, and so hopefully this provides some peace of mind for folks and recourse to take action if they get one of these bills.”
In 2021, Utah legislators passed a law requiring physicians who are not in a patient’s insurance network to bill for their services at in-network rates. The federal law takes it a step further, protecting patients from out-of-network bills that are more than their insurance would pay for in-network services.
Stanford pointed out surveys showed nearly half of Utahns said worrying about unexpected medical bills keeps them from seeking care. She noted the new federal law gives people some options if they are hit with surprise charges.
“They can fight it,” Stanford explained. “They can dispute it, they can reach a resolution without being stuck owing thousands, hundreds of thousands of dollars.”
Stanford added health care consumers still need to ask questions about the billing arrangements, whether they are in an emergency room or undergoing a planned procedure.
“Make sure that they’re going to in-network facilities whenever possible,” Stanford urged. “Those things are still important, even with these protections because you might face different co-pays or coinsurance. There still might be a cost difference.”
Even though the No Surprises Act is federal law, state regulators will be in charge of enforcement. Utahns with concerns over balance billing should contact the health care office at the Utah Insurance Department.
Written by MARK RICHARDSON, producer for Utah News Connection.
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