Patricia Kelmar
Senior Director, Health Care Campaigns, U.S. PIRG Education Fund
U.S. PIRG Education Fund launches consumer education campaign on how to fight back against surprise medical billing
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U.S. PIRG
WASHINGTON — Every year, millions of Americans receive surprise medical bills after unknowingly receiving treatment from a provider outside of their insurance network. Studies have shown that nearly one in five emergency room visits and surgeries results in a surprise out-of-network bill. Although Congress passed the No Surprises Act, a federal law to protect consumers from surprise medical billing in December, it does not go into effect until January 2022. In the meantime, many consumers continue to be at risk for these charges that can cost hundreds or even thousands of dollars.
U.S. PIRG Education Fund and its state affiliates in Arizona, California, Oregon, Colorado, Texas, and Illinois launched a campaign Friday to educate consumers on their rights to push back if they receive a surprise medical bill. The campaign includes tip sheets about current consumer protections under each of those states’ laws. The tip sheets also offer important suggestions for avoiding surprise bills and fighting medical bills.
“Consumers often struggle to understand the pile of bills they receive after a health crisis,” said William McGovern, the U.S. PIRG Education Fund Health Care Campaigns associate. “In particular, out-of-network bills often come as a surprise. Sometimes, patients aren’t even legally obligated to pay them, but they don’t know that. It’s important that consumers have the right information to identify and fight these unfair bills.”
The scope of state protections varies, so consumers need to be familiar with the details of their own state’s laws. However, federal law can override state law. Nationally, 67 percent of Americans are insured by self-funded federally regulated plans, and states are prohibited from regulating these plans that fall under the federal Employee Retirement Income Security Act (ERISA).
“State laws only protect some consumers from some expensive surprise medical bills, so U.S. PIRG worked to pass a federal solution — the No Surprises Act,” said McGovern. “Thanks to that work, the federal law will expand protections to all insured Americans.”
When the No Surprises Act takes effect in January 2022, it will not only extend surprise billing protections to the tens of the millions of people insured by ERISA plans that have been excluded from state protections. It will also cover the insured consumers in the 17 states which currently have no state surprise billing law. The No Surprises Act will also broaden most existing state protections by adding a ban on surprise bills from air ambulances. Unfortunately, the federal law will still leave patients unprotected against one of the most common sources of surprise bills: ground ambulances. Only a few states have banned surprise billing by out-of-network ground ambulances.
See our state resources:
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States with no consumer protections from surprise medical bills: Alabama, Alaska, Arkansas, Hawaii, Idaho, Kansas, Kentucky, Louisiana, Montana, North Dakota, Oklahoma, South Carolina, South Dakota, Tennessee, Utah, Wisconsin, and Wyoming
Updated March 22, 2021