As of January 1, 2022, certain provisions of the “Consolidated Appropriations Act,” commonly referred to as the “No Surprises Act” (Act), are in effect. The Act amends the Public Health Service Act, Employee Retirement Income Security Act, the Internal Revenue Code, and the law governing the Federal Employees Health Benefits Program.

There are two main components to the Act, commonly referred to as the “balance-billing” provisions and the “good-faith estimate” provisions.

Balance-Billing

When is the Balance-Billing Provision Applicable?

This portion of the Act applies when an individual receives emergency care, or non-emergency care from an out-of-network provider at in-network facility.

What is Required?

Patients who receive out-of-network emergency services, or services from out-of-network providers at in-network facilities, generally only will have to pay the amount they would have paid if the services were provided by an in-network provider. This is commonly referred to as a “balance-billing” prohibition, as the patient is not required to pay the difference between what is paid by the patient’s insurance and the out-of-network rates. There are limited exceptions to the balance-billing prohibition if the patient provides informed consent to receive the out-of-network services. There is no balance-billing allowed for emergency services.

Providers must deliver a notice (before requesting payment from the patient), in plain language, stating:

• The balance-billing...

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