Ohio’s No Surprise Medical Billing Law Becomes Effective

Ohio’s No Surprise Medical Billing Law Becomes Effective

COLUMBUS, Ohio – A new Ohio law went into effect Jan. 12 that shields patients from receiving and paying surprise medical bills after certain unanticipated treatment. Surprise medical bills typically range hundreds to thousands of dollars, and a recent national study indicates that unexpected medical bills, including surprise medical bills, lead the list of expenses most Americans fear they cannot afford.

“I appreciate the work of the Ohio Legislature and representatives of the medical and insurance communities for coming together on this issue and for doing what is right for Ohioans,” Ohio governor Mike DeWine said. “Nobody should end up with unexpected medical bills through no fault of their own.”

The law protects patients from receiving and paying surprise medical bills above the patient’s in-network rate from health care providers for emergency care or, in certain circumstances, unanticipated out-of-network care, such as at an in-network health care facility from an out-of-network provider and including lab/pathology services. Cost sharing amounts, which include coinsurance, copayments, and deductibles, are limited to the patient’s lower in-network amounts.

The Ohio Department of Insurance is responsible for administering and enforcing many of the law’s provisions, and addressing complaints from consumers who receive surprise medical bills. The department established a payment reconciliation process for health care providers and health insurers to work through billing discrepancies instead of surprise billing the patient.

“We will be aggressive in order to protect consumers on matters relating to surprise medical billing,” Ohio Department of Insurance director Judith L. French said. “I urge anyone with surprise medical billing questions or concerns to contact us.”

The department, which is conducting a statewide consumer education campaign informing consumers of their rights under the new law, created a surprise medical billing toolkit at www.insurance.ohio.gov to help consumers, health care providers, health insurers, and other stakeholders understand the law and its requirements, and to access the department’s surprise billing services. The department’s consumer hotline is 1-800-686-1526.

A federal surprise medical billing law, called the No Surprises Act, went into effect on Jan. 1. The federal law and Ohio’s law work together to protect consumers in surprise billing situations.