New rule, to take effect Jan. 1, will limit surprise billing from air (not ground) ambulances and other emergency providers

On Jan. 1, the Biden administration will finally implement new rules that limit so-called surprise bills from out-of-network medical providers —including air ambulances — needed in an emergency.

"Passed as part of the omnibus legislation to fund the federal government in 2021, as well as provide Covid-19 pandemic relief funds, the No Surprises Act’s new rules and requirements would protect consumers from out-of-network bills and balance billing," Liz Carey reports for The Daily Yonder. "Currently, when an insurance plan doesn’t cover out-of-network care, the insurer may deny a patient’s bill entirely, or only pay a portion of the bill. When this happens, it leaves the patient liable for the balance of the bill – the difference between the undiscounted fee charged by the provider and the amount reimbursed to the provider by the insurance plan. Balance billing can leave patients on the hook for hundreds, if not thousands of dollars."

But "under the new rules, in emergencies, out-of-network providers would only be allowed to bill what in-network providers would bill, and they would be prohibited from billing the patient for whatever insurance doesn’t cover," Carey reports. "The Centers for Medicare & Medicaid Services estimated the median cost for air ambulance transportation at between $36,000 and $40,000. While air ambulance providers are not allowed to send surprise bills to Medicaid or Medicare patients, patients with private insurance often find that their air ambulance trips are out-of-network, leaving them with surprise bills in the tens of thousands of dollars." The 2021 law does not apply to ground ambulances, which have the highest out-of-network billing rates of any medical specialty, according to The New York Times.