TDCI: Consumers Gain New Protections Under Federal No Surprises Act

Federal Law Took Effect January 1, 2022
Wednesday, January 12, 2022 | 02:43pm

NASHVILLE – The Tennessee Department of Commerce & Insurance (TDCI) reminds consumers they have new protections from out-of-network medical bills related to either emergency or non-emergency care under the federal No Surprises Act, which took effect January 1, 2022.

Surprise billing occurs when a patient receives an unexpected medical bill after receiving care from an out-of-network provider (such as a doctor) or at an out-of-network facility (such as a hospital). This often occurs when a consumer does not know a provider is out-of-network even though they received care at an in-network facility.

Under the No Surprises Act, a provider may no longer charge the individual for the difference between their charge and the health insurers’ allowed amount. The new law ensures Tennesseans and their loved ones can receive the emergency and elective care they need without fear of receiving a surprise bill. 

“Surprise bills affect every community, in every corner of the state. I constantly meet with families who are struggling to recover from medical debt due to surprise bills,” said TDCI Commissioner Carter Lawrence. “The No Surprises Act gives Tennessee consumers protection from the risk of surprise bills that can lead to greater expenses, headaches, and frustrations.”

TDCI’s bulletin to Tennessee health care providers and facilities about the No Surprises Act can be seen here.

Tennesseans are shielded under the No Surprises Act, which includes provisions to:

  • Hold patients harmless from surprise medical bills, including air ambulance providers, beyond the applicable in-network cost sharing amount for surprise bills.
  • Require a provider give a patient notice of their network status and an estimate of charges 72 hours prior to receiving out-of-network services, where the patient also must provide consent to receive out-of-network care.
  • Create a framework to allow health care providers and insurers to resolve payment disputes without causing the patient to pay the difference.
  • Provide additional consumer protections if an insurance company adjusts their network. Under the No Surprises Act, if a consumer receives care from a provider who appears on an outdated list of in-network providers, the consumers have to be billed at in-network cost.
  • Allow uninsured consumers (or those who decide to not use health insurance to cover the cost of a service) to get a good faith estimate of the cost of the care up front, before a visit.

TDCI’s team stands ready to be a resource for consumers with questions about medical bills or who feel they’ve been incorrectly billed,” said TDCI Assistant Commissioner Bill Huddleston. “Consumers whose claims are wrongfully denied should contact our team and file a complaint today.”

A new blog post about the protections in the No Surprises Act can be seen here.

To file a complaint, consumers should visit TDCI’s website or call TDCI’s Consumer  Insurance Services team at 1-800-342-4029 or (615) 741-2218.

For a list of Frequently Asked Questions related to the No Surprises Act, visit the Centers for Medicare and Medicaid Services (CMS) website.

For more Tennessee insurance consumer information, visit today.