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Federal “No Surprises Act” Brings National Oversight Of Unexpected Billing For Healthcare Services

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In the waning days of Donald Trump’s administration, the federal government passed the “No Surprises Act,” which becomes effective January 1, 2022. Like many recent state laws, the legislation is aimed at protecting patients from unexpected balances owed to healthcare providers outside of their network plans, particularly when there was no advance notice of the potential bills, as would often occur with respect to emergency services, or services from hospital-based providers when those providers are not in the patient’s insurance plan network. The legislation seeks to remove patients from the middle of out-of-network reimbursement disputes.

Overview of Federal and NJ/NY State Laws

The reach of state laws addressing these issues has been limited, largely due to three reasons:

> State laws relating to employee benefit plans that are not insured are preempted by the Federal Employee Retirement Income Security Act (ERISA);

Federal laws governing some government programs, such as Medicare Advantage and the Federal Employees Health Benefits Plan covering federal employees, also preempt many state insurance laws; and

State insurance laws are generally limited to insurance policies issued in that state, so a New York resident insured under an employer’s Pennsylvania group policy may not fall under the protection […]

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