The end of 2020 saw Round 2 of Coronavirus relief, as President Donald Trump signed the Consolidated Appropriations Act into law. Among many provisions, the law contains one that is particularly relevant to employer group health plans: A ban on surprise medical bills (known more technically as “balance bills”).
Surprise bills typically originate from out-of-network providers, where the provider bills the employee for the difference between what the health plan paid for care and the original “billed amount.” Effective January 1, 2022, this will no longer be permitted.
- Providers are no longer allowed to simply surprise bill the member and, instead, will now have 30 days to come to an agreement with the health plan covering the member.
- If no agreement can be reached, the matter will be turned over to an independent third party in a process known as IDR (“Independent Dispute Resolution”)
- Specific details about the IDR are forthcoming. We will be monitoring the issue closely.
Feel free to take a copy of the Surprise Medical Billing ban with you for now.