On Jan. 1, a new law will go into effect limiting "surprise" medical bills, or bills patients receive for out-of-network (OON) care, in emergency settings and from out-of-network providers at in-network facilities. The No Surprises Act, enacted in December 2020, is part of the 2020 year-end omnibus spending bill known as the Consolidated Appropriations Act of 2021.

What kind of care does the No Surprises Act apply to?

The No Surprises Act imposes requirements on health care facilities, providers, and group health plans and health insurance issuers offering group or individual health insurance coverage in three distinct areas:

• Emergency services

Under the No Surprises Act, a health plan that provides emergency coverage must provide that coverage without prior authorization, without regard to whether a facility is in-network or OON, and regardless of other terms of the plan (except for exclusions or coordination of benefits). Health plans also cannot deny claims for emergency coverage based on an after-the-fact assessment of the care provided, any purported delay between when symptoms began and when the patient sought care, or based on how long the symptoms were present.