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Controlling Health Care Costs

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State Balance-Billing Protections

Authors
Maanasa Kona
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PLEASE NOTE: The No Surprises Act is a new federal law enacted by Congress in December 2020. As noted in this interactive, some states have laws that have protected some state residents from surprise bills. The No Surprises Act will now protect all consumers with private health insurance— including the more than 163 million people with job-based coverage — from out-of-network surprise bills in certain situations. These new protections go into effect for health plan years that begin on or after January 1, 2022. Key rules implementing the new federal law were issued in July and September 2021.

“Balance bills” primarily occur in two circumstances: 1) when an enrollee receives emergency care either at an out-of-network facility or from an out-of-network provider, or 2) when an enrollee receives elective nonemergency care at an in-network facility but is inadvertently treated by an out-of-network health care provider. Since the insurer does not have a contract with the out-of-network facility or provider, it may decide not to pay the entirety of the bill. In that case, the out-of-network facility or provider may then bill the enrollee for the balance of the bill. 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 federal law goes into effect on January 1, 2022.

See here for the criteria used to determine which states have comprehensive or partial protections.

Select a state to learn how it protects consumers against balance billing

Select a state

Click on a state to learn how it protects consumers against balance billing

PROTECTIONS AVAILABLE

    Notes:

    Source

    Maanasa Kona et al., Center on Health Insurance Reforms, Health Policy Institute, Georgetown University. Please contact Maanasa Kona for questions about this map.

    ADDITIONAL RESOURCES

    Jack Hoadley, and Kevin Lucia, and Beth Fuchs, "Surprise Billing Protections: Help Finally Arrives for Millions of Americans," To the Point (blog), Commonwealth Fund, Dec. 17, 2020.

    Jack Hoadley, Maanasa Kona, and Kevin Lucia, "States Can Prevent Surprise Bills for Patients Seeking Coronavirus Care," To the Point (blog), Commonwealth Fund, Apr. 29, 2020.

    Jack Hoadley and Maanasa Kona, "How States Are Using Independent Dispute Resolution to Resolve Out-of-Network Payments in Surprise Billing," To the Point (blog), Commonwealth Fund, Feb. 27, 2020.

    Maanasa Kona, Jack Hoadley, and Katie Keith, "Addressing Surprise Billing by Setting Payment Standards for Out-of-Network Providers," To the Point (blog), Commonwealth Fund, Feb. 27, 2020.

    Publication Details

    Date

    Contact

    Maanasa Kona, Assistant Research Professor, Center on Health Insurance Reforms, Health Policy Institute, McCourt School of Public Policy, Georgetown University

    [email protected]

    Citation

    Maanasa Kona, “State Balance-Billing Protections,” map, Commonwealth Fund, last updated Feb. 5, 2021. https://doi.org/10.26099/0x7j-7731

    Area of Focus

    Topics

    Coverage and Access,
    Government Programs & Policies,
    State Health Policy,
    Costs and Spending,
    Affordability,
    Medical Bills and Debt,
    Surprise Billing

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