As Tennessee’s insurance regulator, our department’s role is to closely supervise insurers in the Volunteer State as we strive to balance responsible regulation while protecting hardworking Tennessee families.

One persistent frustration that has affected both consumers and regulators across the country has been surprise bills, which are sometimes called “balance” bills.

Balance billing occurs when an out-of-network health care provider or facility bills a patient after the patient’s health insurance company has paid its share of the bill. In some cases, a patient may choose to receive care from an out-of-network provider or facility understanding the cost will be higher.

Surprise billing occurs when the balance bill is unexpected. That is, the consumer did not know the provider or facility was out-of-network when they received care. This occurs with both emergency and non-emergency care.

The bottom line is that consumers should not risk being punished with surprise medical bills after an emergency or after receiving any medical service.

Unfortunately, state regulators have had little support from our federal counterparts when it comes to addressing these unfair practices and instituting real change to help protect consumers.

As of Jan. 1, Tennessee consumers no longer have to worry about surprise medical bills thanks to the newly enacted No Surprises Act.

The No Surprises Act is the result of a yearslong bipartisan effort in Congress to help better protect consumers.

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, which is related to either emergency or non-emergency care, ensures Tennesseans and their loved ones can receive the emergency and elective care they need without fear of receiving a surprise bill.

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.

For a list of Frequently Asked Questions related to the No Surprises Act, visit the Centers for Medicare and Medicaid Services’ website at www.cms.gov/files/document/nosurpriseactfactsheet-final508.pdf .

For additional information, TDCI’s bulletin to Tennessee health care providers and facilities about the No Surprises Act can be seen online at www.tn.gov/content/dam/tn/commerce/documents/insurance/bulletins/010722_NSA_Bulletin-22-01.pdf .

If Tennessee consumers should experience a surprise bill, they should file a complaint with our team. 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.

The writer is the assistant commissioner for insurance at the Tennessee Department of Commerce & Insurance.

Recommended for you