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New Year, No Surprises? What You Need to Know About the Latest Patient Protection Act

Opening a letter from your health insurance provider to find an unexpectedly high bill due to out-of-network charges can be an alarming and even life-altering development. If you are saving for retirement or already living on a fixed budget in your golden years, such a bill can take months to pay off.

There is good news: This type of surprise should now be a thing of the past. A federal law recently went into effect that protects patients from unexpected bills like this. Often patients don’t realize that a doctor or hospital is not in their network. Sometimes they may not have even chosen this doctor, such as when seeking emergency care.

From now on, the new law says, patients will only pay their in-network sharing costs when they find themselves in that situation. The No Surprise Act went into effect in December.

Also last month, Gov. Tom Wolf also signed an executive order putting the Pennsylvania Insurance Department in charge of keeping consumers out of billing disputes between providers and insurers, which could lead to long hours on the phone trying to straighten out who was responsible for what charge and arguing over whether the out-of-network prices were preapproved or justified. Stunned consumers often ended up paying the bills because they didn’t feel they had another choice.

Now, if a patient receives a “surprise bill,” they can contact the PID, which will help answer questions or file a complaint for them.

“The Insurance Department has received numerous complaints about surprise bills over the past few years,” said Insurance Commissioner Jessica Altman last month when the executive order was issued. “Our medical system is complicated enough. The primary concern following major medical procedures should be recovery, not worry over medical billing.”

‘A Game-Changer’ for Pennsylvanians

Gov. Wolf hailed the new law as “a game-changer” and says it will make health care more accessible to all residents of the commonwealth.

“A patient who has carefully researched and selected an in-network facility and provider or is seeking care because of an emergency should not be stuck with out-of-network costs and billing when they had little or no choice regarding providers that may, in the end, be out-of-network,” said Gov. Wolf. “The Wolf administration has been committed to protecting consumers from balance billing, and the implementation of the No Surprises Act is a major step toward ending unexpected, upsetting and many times financially devastating medical bills.”

A Far-Reaching Impact for the No Surprise Act

Why was this legislation so critical to pass? Many people get hurt by surprise bills. The Pennsylvania Health Access Network (PHAN), which focuses on making health care more affordable and accessible, says that one in three Pennsylvanians has received them.

Unfortunately, noted Antoinette Kraus, executive director of PHAN, those people often have no idea where to turn for help when such a bill shows up in their mailbox. "The No Surprises Act is a game-changer that will allow patients to focus on their care rather than worrying about unexpected bills, even when they did everything right and sought in-network care," she said.

Health care billing and insurance matters can be confusing. Do you have questions about finding the best care? Contact Jay to get the answers you need about the No Surprise Act and other health care-related topics.


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