A surprise medical bill is a large, unexpected bill charged to an insured patient for healthcare services performed by an out-of-network medical provider they did not choose. This usually results when a patient unknowingly treats with an out-of-network provider at an in-network facility or receives emergency treatment from an out-of-network provider.
A medical provider is “out-of-network” when the provider does not have a contract with the patient’s health insurer for an agreed upon reimbursement rate for healthcare services. Treating with an out-of-network provider usually results in higher cost sharing, such as a balance bill charged to the patient for the difference between the amount charged by the provider and the amount paid to the provider by the patient’s health insurance plan (known as “balancing billing”).
The federal No Surprises Act, which went into effect on January 1, 2022, protects patients with fully insured and self-insured health plans from certain surprise medical bills. The protections apply to most emergency services, including at hospital emergency rooms and air ambulance transportation. Notably, however, the protections do not apply to ground ambulance services. Instead, the act establishes an ambulance advisory committee to address balance billing by ground ambulance services, including recommending state action and legislative options.
The federal law supplements Connecticut’s laws concerning surprise medical bills and balance billing, Connecticut General Statutes Sections 38a-477aa and 20-7f. However, Sections 38a-477aa and 20-7f exclude from the definition of “health care provider” individuals licensed to provide health care services under chapters 368d and 384d, namely, ambulance services, EMTs, and paramedics.
For the time being, under both federal and Connecticut law, out-of-network ground ambulance services may balance bill patients. However, these laws could change in the future.