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.