What You Need to Know
- The No Surprises Act is supposed to reduce the odds that insured patients will end up with big, unexpected bills for out-of-network care.
- Providers are supposed to give patients good-faith estimates of what the bills would be.
- When an actual bill is $400 or more higher than the estimate, the patient can take the provider to dispute resolution.
The No Surprises Act — a new federal law that’s supposed to keep patients from getting big, unexpected medical bills — could keep some patients from getting care when they want to get care, and it could lead to a barrage of questionable disputes with others, doctors and hospitals are telling federal regulators.
One primary care doctor said the act may keep an insured patient who scheduled a checkup far in advance, and then loses coverage, from getting the checkup, even if the patient still wants the checkup.
An executive from a hospital group suggested that the current rules could lead to headaches for a surgical team that needs 15 more minutes than expected to complete a procedure.
Providers are sharing those concerns about No Surprises Act implementation in comments on “Requirements Related to Surprising Billing; Part II.” That’s one of the sets of regulations federal agencies developed to put the new law into effect.
What It Means
You may have clients who use health savings accounts or ordinary savings to pay for some medical care.
Even if you have no direct role in health insurance or health care cost planning, you should encourage those clients to be aware of the possibility of problems, see if they can talk to providers’ billing teams before getting care, and try to communicate with surgical teams about what should happen if procedures take longer than expected.
The No Surprises Act System
In the past, many insured patients went to in-network hospitals, or to out-of-network hospitals for emergency care, and discovered that they had received high bills for care priced at out-of-network rates.
Congress put the No Surprises Act in the Consolidated Appropriations Act, 2021, in an effort to fix that problem.
Parts of the act require a provider to give a patient a “good faith estimate” of what the patient’s share of the bill will be.
If the actual bill is more than $400 higher than the estimate, the patient may be able to use a new dispute resolution system to dispute the bill.
The Part II implementation regulations appeared in the Federal Register on Oct. 7 and took effect on that date. They began to apply for health plan or health insurance policy years beginning on or after Jan. 1, 2022.