The No Surprises Act took effect Jan. 1, thanks to efforts from the effort the pulmonary hypertension (PH) and rare disease communities.

The law applies to people with employer-provided or individual health insurance, such as marketplace plans. It protects them from being billed for out-of-network care in situation where they can’t choose a provider, such as emergency care.

The PH community was integral to the law’s passage because they shared their stories with lawmakers about financial burdens caused by surprise medical bills. The Pulmonary Hypertension Association (PHA) is working to ensure the bill is properly implemented and operates as intended.

As a result of the new law, insurance plans must bill the following at in-network rates:

  • Emergency services in hospital emergency rooms or departments. Although the law applies to air ambulance service, the No Surprises Act doesn’t apply to ground ambulance service. PHA and rare disease advocates are working to expand the coverage to ground service.
  • Post-emergency stabilization care at an out-of-network hospital, until a patient is stable enough to be transferred to an in-network care site and give written consent to be transferred.
  • Non-emergency services at in-network facilities. Some physicians who work at in-network facilities aren’t part of the insurance plan’s network. The No Surprises Act ensures that care provided by those providers at an in-network facility will be billed at in-network rates.

In some non-emergency situations, providers can ask consumers to waive their rights under the No Surprises Act. If a consumer waives their rights, they can be billed full out-of-network rates. If you are asked to waive your rights, review the waiver carefully and seek additional information about your options.

The No Surprises Act doesn’t apply to Medicare and Medicaid coverage. Medicare and Medicaid already limit billing by non-network providers.

While the No Surprises Act was moving through Congress, PH advocates shared their personal stories about the importance of this legislation.

More recently, PHA joined a community letter to the departments of Health and Human Services, Labor and Treasury that called for implementation of the No Surprises Act must provide “consumers with clear, comprehensive protections against surprise bills where they have not knowingly obtained out-of-network care.”

Learn more about PHA’s advocacy priorities and how you can take action. Questions? Contact us or call 301-565-3004 x758.