42 U.S.C. § 300gg–131 — Balance billing in cases of emergency services

submitted 82 years ago by Pub. L. 116-260 to r/title-42-THE-PUBLIC-HEALTH-AND-WELFARE · 320 words · no verdicts yet

in plain englishAI-generated · not legal advice

If you get emergency care, hospitals, ERs, and the doctors who treat you there can't bill you more than your normal in-network cost-sharing amount, even if they're out-of-network. This protection applies no matter who actually provides the care during that emergency visit.

(a) In general For plan years beginning on or after January 1, 2022, if you're covered by a group health plan or health insurance and you get emergency services — covered under your plan — during a visit to a hospital emergency department or an independent freestanding emergency department, two protections apply. If the emergency department itself is out-of-network, it can't bill you, or hold you responsible for paying, more than your normal in-network cost-sharing amount for those services, calculated the way section 300gg–111(a)(1)(C) and its parallel provisions in the tax code and labor code describe. And if an out-of-network doctor treats you during that same visit, that doctor also can't bill you, or hold you responsible, for more than your normal in-network cost-sharing amount for what they did. (b) Definition "Visit" has the same meaning here as it does under section 300gg–111(b).

the actual law source: uscode.house.gov ↗public domain

(a) In general

In the case of a participant, beneficiary, or enrollee with benefits under a group health plan or group or individual health insurance coverage offered by a health insurance issuer and who is furnished during a plan year beginning on or after January 1, 2022, emergency services (for which benefits are provided under the plan or coverage) with respect to an emergency medical condition with respect to a visit at an emergency department of a hospital or an independent freestanding emergency department—

(1)

in the case that the hospital or independent freestanding emergency department is a nonparticipating emergency facility, the emergency department of a hospital or independent freestanding emergency department shall not bill, and shall not hold liable, the participant, beneficiary, or enrollee for a payment amount for such emergency services so furnished that is more than the cost-sharing requirement for such services (as determined in accordance with clauses (ii) and (iii) of section 300gg–111(a)(1)(C) of this title, of section 9816(a)(1)(C) of title 26, and of section 1185e(a)(1)(C) of title 29, as applicable); and

(2)

in the case that such services are furnished by a nonparticipating provider, the health care provider shall not bill, and shall not hold liable, such participant, beneficiary, or enrollee for a payment amount for an emergency service furnished to such individual by such provider with respect to such emergency medical condition and visit for which the individual receives emergency services at the hospital or emergency department that is more than the cost-sharing requirement for such services furnished by the provider (as determined in accordance with clauses (ii) and (iii) of section 300gg–111(a)(1)(C) of this title, of section 9816(a)(1)(C) of title 26, and of section 1185e(a)(1)(C) of title 29, as applicable).

(b) Definition

In this section, the term “visit” shall have such meaning as applied to such term for purposes of section 300gg–111(b) of this title.

Source credit: (July 1, 1944, ch. 373, title XXVII, § 2799B–1, as added Pub. L. 116–260, div. BB, title I, § 104(a), Dec. 27, 2020, 134 Stat. 2824.)

history & why it existsrecord from the source credit

1944Enacted · Pub. L. 116-260 · 134 Stat. 2824

A history note hasn’t been published yet. The record shows enactment by Pub. L. 116-260 on 1944-07-01.

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