Utah enacted balance billing protections in 2020, making it one of the early states to address surprise billing. These protections work in tandem with the federal No Surprises Act.
Utah HB 258 (2020) and Code §31A-22-635
Utah HB 258, effective January 1, 2021, added Code §31A-22-635 and protects patients from balance billing for emergency services and scheduled non-emergency services at in-network facilities. This predates the federal No Surprises Act by one year.
In-Network Cost-Sharing Only
Under Utah's balance billing law, patients receiving covered services pay only in-network cost-sharing amounts. Out-of-network providers must bill the insurer for the remaining balance—they cannot collect excess amounts from patients.
Utah Insurance Department Enforcement
The Utah Insurance Department (UID) enforces Code §31A-22-635. Violations may result in refunds to patients and civil penalties against insurers. The UID conducts market conduct reviews of pattern violators.
Concurrent Federal No Surprises Act (January 1, 2022)
The federal No Surprises Act, effective January 1, 2022, applies concurrently with Utah's state law. When both rules apply, the greater protection for the patient applies.
How to Dispute Balance Bill Under Utah Law
- Confirm the service qualifies under Utah Code §31A-22-635 (emergency or scheduled at in-network facility).
- Contact the health plan citing Utah balance billing law and federal No Surprises Act.
- Request an in-network rate adjustment with supporting bill documentation.
- File a UID complaint if the plan refuses to adjust within 30 days.
Altair identifies Utah balance billing violations and enforces your rights.
Frequently Asked Questions
When did Utah's balance billing law take effect?
Utah HB 258 took effect on January 1, 2021, making Utah one of the early states to enact balance billing protections.
Does Utah's balance billing law cover air ambulance?
Air ambulance services may fall outside standard balance billing protections, but emergency transport is generally covered. Consult the UID if you encounter an air ambulance balance bill.
Can patients waive balance billing protections in Utah?
No, neither Utah Code §31A-22-635 nor the federal No Surprises Act allow patients to waive protections. Any waiver agreement is void.
Related Utah Insurance Topics
- Utah Timely Filing Requirements
- Utah Surprise Billing Protections
- Utah Prior Authorization Rules
- All State Billing Laws
- Federal No Surprises Act