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Insurers Scramble to Meet No Surprises Act Requirements

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What You Need to Know

  • Seventy-four percent of respondents are concerned about meeting the law’s Advanced Explanation of Benefits mandates, a Zelis survey found.
  • Sixty-three percent said they do not know how they are going to obtain the provider estimates required for AEOBs.
  • The 73% of insurers that rely on paper-based systems for payments should make a plan to digitize and streamline those processes.

A majority of health care insurers are concerned about meeting the cost transparency requirements of the No Surprises Act, which seeks to protect patients from unexpected medical bills, according to a recent survey from Zelis, a health care payments company.

Zelis conducted a survey in July of 119 health care payer executives representing 98 payer health plans, third-party administrators and health plan-owned TPAs.

Seventy-four percent of respondents said they are concerned about meeting the act’s Advanced Explanation of Benefits requirements, which apply to both in- and out-of-network care. 

Zelis noted that under the law as written, a provider must send an estimate of expected charges for any health care service to the patient’s insurer. With that information, the insurer creates an AEOB, including the patient’s out-of-pocket estimates, and sends it to the patient before the scheduled service.

Sixty-three percent of respondents said they do not know how they are going to obtain the provider estimates required for AEOBs. Fifty-eight percent expressed uncertainty about their ability to obtain the additional data required for AEOBs.

In a survey conducted in January, Zelis found that nearly all providers worried about their ability to adjust their systems, processes and technological capabilities to comply beginning Jan. 1, 2022.

“The AEOB requirements are going to be a heavy lift for many insurers, considering 73% rely on paper-based processes for payments and more than half aren’t sure how to get the necessary pricing data,” Matthew Albright, Zelis’ chief legislative affairs officer, said in a statement. 

“Any insurer still using paper-based billing and member communication should make a plan now to digitize and streamline those processes and make them more efficient, data-driven and faster. Those with outdated systems will struggle to comply with the NSA and will likely experience greater challenges, higher costs, and more administrative work than before.”

Zelia chief executive Amanda Eisel said that the No Surprises Act is a call to action for the health care industry to better serve and support health plan members. 

“Now more than ever, insurers and providers must collaborate to successfully navigate the complexity of the law,” Eisel said in the statement. “Innovative solutions that can be seamlessly integrated are critical.”