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Consumer Reports Highlights What is Not Covered by Federal No Surprises Act

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The federal ‘No Surprises Act‘, designed to protect consumers from surprise out-of-network medical bills, came into effect on January 1 2022 (AHT, 10/5/21). Consumer Reports identifies what the ‘No Surprises Act’ does not cover:

Many urgent care centers are not covered. The federal law only applies to urgent care facilities that are licensed to provide emergency medical services. Urgent care centers may not be licensed by the state to provide actual emergency care and therefore are not subject to the new law.

Retail clinics, located in drugstores or supermarkets, that offer a narrow set of tests and treatments, may or may not be covered by insurance and therefore may be subjected to surprise medical billing arising from visits for non emergency care.

Birthing Centers, Hospice Facilities, and Addiction Treatment Centers: These type of of facilities are only covered by the federal law if they are affiliated with a hospital.

Ground ambulances: Many ambulances operate out of police or fire departments or other government agencies, which in some states or localities are prohibited from contracting directly with insurers, and therefore not included in the federal law. However, at least 10 states—Colorado, Delaware, Florida, Illinois, Maine, Maryland, New York, Ohio, Vermont, and West Virginia—have some level of surprise billing protections around ground ambulances. The new law does offer protection against surprise medical bills for an air ambulance—both via airplane or helicopter.

Surprise billing at the doctors office: for non-emergency, non-hospital care, consumers still need to choose in-network doctors. However, all lab tests or diagnostic screenings also need to be from in-network facilities and providers. Michigan and New Mexico have laws to protect patients even at the doctor’s office.

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