Starting in the new year, surprise medical bills from doctors outside a patient's health insurance network will be illegal.
The federal No Surprises Act goes into effect Jan. 1, which means patients will no longer have to pay more than their health policies stipulate for care — regardless of who is providing the services — unless the patient agrees otherwise.
The law targets doctors outside a patient's health insurance network who bill separately for care, often at full cost and without the patient knowing the doctor is out of network.
Pennsylvania will enforce the law through the state Insurance Department, which will field consumer complaints and offer guidance, Commissioner Jessica Altman said.
"It's a new consumer protection, and we're making it as easy as possible to navigate," Altman said. "We are a one-stop shop."
The department has received numerous complaints about surprise bills in recent years, she said, which led to efforts to enact state protections. Ultimately, those efforts failed, but they were replaced by the new federal law.
Former President Donald Trump signed the bill into law in December 2020, which followed two years of hearings, markups, campaign ads and negotiations. Enactment also followed numerous patient complaints about getting billed from doctors outside the patient's network for care rendered during childbirth or treatment in an emergency room, when the provider's status wasn't clear.
The American Hospital Association and American Medical Association have sued the federal government over what the groups say is a narrow but crucial provision in the law that includes the option of insurers and doctors settling billing disputes through arbitration.
Trade groups say that arbitration will result in billing disputes relying on a median rate for a particular service rendered, unfairly benefiting commercial health insurers.
The lawsuit, which was filed in the U.S. District Court for the District of Columbia, will not impede the law's core protections or result in higher out-of-pocket costs to patients, the trade groups said.
The No Surprises Act is meant to protect consumers with employer-provided health care coverage or with policies sold through the state's Affordable Care Act marketplace, which is called Pennie.
It does not apply to consumers with Medicare, Medicaid, CHIP or Tricare because these programs already have separate balance billing protections.
