Editor's note: Be sure to read the other articles in this series:

• Consolidated Appropriations Act deep dive: Impact on Families First Coronavirus Relief Act's paid leave provisions
• Consolidated Appropriations Act deep dive: Health and dependent care flexible spending accounts
• Consolidated Appropriations Act deep dive: The Paycheck Protection Program and Employee Retention Tax Credit

One of the many components of the Consolidated Appropriations Act of 2021 is the "No Surprises Act." This section of the new law does not directly address COVID-19 economic relief, but instead gets at a longstanding health policy concern, the issue of "surprise" balance billing. It bans these "surprise" bills in certain circumstances and establishes a federal procedure to handle many types of disputed out-of-network medical claims.

Surprise billing occurs when individuals get medical care outside of their plan's network, and their providers and health plans cannot agree on a payment amount acceptable to the provider. In those cases, patients often get a "balance" bill for amounts charged by the provider but not paid by their health plan. While no one likes medical bills, they are particularly shocking and unwelcome when patients do not get to pick their provider, such as in a medical emergency. It's also very frustrating when a patient carefully selects an "in-network" health care facility but later receives a bill from a provider who, unbeknownst to the patient, does not have a contractual agreement with their health plan.

Federal and state-level lawmakers have been grappling with potential solutions to the issue of surprise balance billing for many years. Seventeen states already have comprehensive laws addressing surprise bills, and 15 others have some billing protections in place for consumers, particularly for those with fully-insured or state-sponsored health insurance coverage. The new federal law creates a uniform level of protection that applies to all group and individual major medical plans nationwide, including those that offer fully-insured coverage and self-funded group health plans. The measure sets a floor of federal requirements, but it specifically does not preclude states from adopting even stricter standards for insurers and health care providers under their jurisdiction. The law is also clear that if a state already has a specific financial benchmark for billing disputes, that standard will apply to the affected entities in federal cases raised in their state.