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State Laws Protecting Consumers Against Balance Billing, as of February 5, 2021. States with comprehensive protections. WA. NH VT. (18 states) States with partial protections. (15 states) States without protections. (17 states and D.C.)
Requirement: No balance billing for out-of-network emergency services. No balance billing for certain non-emergency services by out-of-network providers during patient visits to in-network health care facilities, unless notice and consent requirements are met. Review and download Standard Notice and Consent Documents.
While 33 states have enacted laws to protect enrollees from balance billing, the scope of these protections varies as shown in the map below. Congress enacted the No Surprises Act in 2020 to protect most people who are not currently protected under this patchwork of state laws.
This interactive map summarizes the roles of the federal and state governments on various aspects of the No Surprises Act, including enforcement, specified state laws for payment determination, the use of external review for surprise-billing cases, and the patient–provider dispute resolution process.
In addition to any out-of-network cost sharing you might have owed, the out-of-network provider or facility could bill you for the difference between the billed charge and the amount your health plan paid, unless banned by state law. This is called “balance billing.”
States have taken various legislative approaches to protect consumers from surprise balance billing, from outright prohibitions on surprise balance billing in certain circumstances to transparency requirements that enhance consumer education and awareness of out-of-network health care services. This chart highlights multiple provisions that states
An unexpected balance bill is called a surprise bill. The Consolidated Appropriations Act of 2021 was enacted on December 27, 2020 and contains many provisions to help protect consumers from surprise bills, including the No Surprises Act under title I and Transparency under title II.
In this post, we’ll dive into various details to know about balance billing laws by state and the federal laws, regulations and protections against balance billing. We’ll also discuss what these balance billing laws mean, and how they affect you as the individual.
The 2020 No Surprises Act (NSA) established new federal protections against surprise medical bills and balance billing, most of which took effect January 1, 2022. Below is a summary of the major No Surprises Act requirements and what they mean for you.
See below for information on state balance billing laws in Arizona, Florida, Iowa, Minnesota and Wisconsin. Certain services at an in-network hospital or ambulatory surgical center. When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network.