The Federal No Surprises Act Is Here: What Does It Mean For California?

Too often, surprise medical bills have created a financial burden for Americans. In California, a 2017 law banned bills from healthcare providers who don’t participate in the patient’s insurance network. Unfortunately, people who benefit from self-funded plans, e.g., health coverage through employers, are not protected. These plans are regulated by the U.S. Department of Labor and not the state.

According to a 2020 study, one in five privately insured patients received unexpected bills from out-of-network providers after having elective surgery at a participating hospital. Fortunately, as of January 1, 2022, this gap in consumer protection has been closed across the United States following the entry into effect of the federal No Surprises Act. Insured patients are protected from cost-sharing and balance billing for emergency and non-emergency services from out-of-network providers at in-network facilities.

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However, to avoid any surprises and spot illegitimate bills, patients should still investigate beforehand the details of their insurance policies as well as their rights. They can also contact their insurer, the Department of Managed Health Care, the federal “No Surprises” help desk, or even the Health Consumer Alliance.