The No Surprises Act: Fair warning for medical expenses.

• Author: Simonelli, Isaac Stone
• Position: HEALTHCARE

A health emergency is already an unwelcome surprise; an unexpected medical bill only adds to the injury. Take, for example, the cost of an ambulance or the enormously expensive air transport off Alaska's road system or to out-of-state hospitals.

"That's where we see the biggest delta and kind of the most expensive billing situations," says Tiffany Stock, vice president of marketing and client relations at RISQ Consulting in Anchorage.

To alert consumers to medical expenses they might not be able to afford. Congress passed the No Surprises Act in late 2020. Its ban on unexpected bills from out-of-network providers, out-of-network facilities, and out-of-network air ambulance providers took effect at the start of 2022.

The result is an end to surprise billing--also referred to as balance billing-in private insurance for most emergency care and many instances of non-emergency care, according to the US Department of Health and Human Services (DHHS). Balance billing is when a patient is stuck with the difference between the amount a provider bills and the amount the patient's insurance pays.

"In general, unexpected healthcare expenses could have a huge impact on someone's life," says Jim Grazko, Premera's senior vice president of the Alaska market and chief underwriting officer.

A report by DHHS found that such bills, common among privately insured patients, could average more than $1,200 for services provided by anesthesiologists, $2,600 for surgical assistants, and $750 for childbirth-related care.

In a variety of situations, especially emergencies, patients have little to no options of what air ambulance service they use, what facility they end up at, or what physicians carry out a procedure-even if these services are out of network. When it comes to elective care, a patient does not typically get to choose their anesthesiologist, assistant surgeon, or other ancillary providers.

"The biggest one we see is when someone has a planned in-hospital procedure at their in-network hospital, and they have an anesthesiologist--but you don't get a choice of the anesthesiologist--and they're not contracted with any insurance carrier," Stock says. "So, we've seen a lot of balanced bills in those situations."

Many people who walk into a hospital don't understand the complex relationship between all the different providers that handle their case, explains Amy Miller, the CFO for Providence Alaska.

"Not every physician that works within the Providence Hospital is a Providence employee. In fact, most of them are not," Miller says, noting that...