On December 27, 2020, the No Surprises Act was passed and signed into law. Congress declared that the protections included in the No Surprises Act will go into effect for plan or policy years beginning on or after January 1, 2022. While it’s unfortunate that another year must pass in order for this new legislation to take effect, it’s a great development in the world of medical bills. Medical bills, you see, will no longer come as a surprise.
As announced by the U.S. Senate Committee On Health, Education, Labor & Pensions, the bipartisan, bicameral agreement protects patients from surprise medical bills. It also establishes a fair payment dispute resolution process.
Patients are protected in a number of ways.
As mentioned, the No Surprises Act holds patients harmless from surprise medical bills. Such bills may include air ambulance providers. Patients are assured that they are only held responsible for their in-network cost-sharing amounts. These may include deductibles, in both emergency situations and certain non-emergency situations where patients do not have the ability to choose their own in-network providers.
The new legislation also prevents certain out-of-network providers from balance billing patients unless the providers give the patients notices of their network statuses. They must also provide estimates of charges 72 hours prior to receiving out-of-network services. As well, patients must provide consent to receive out-of-network care.
Patients no longer have to be involved in payment disputes.
The No Surprises Act enables health care providers and insurers to resolve issues without involving patients. Insurers will pay providers that are determined either through negotiation between the parties or an independent dispute resolution (IDR) process. There is no minimum payment threshold to enter IDR. In addition, claims may be batched together to ease administrative burdens.
“If the parties choose to utilize the IDR process, both parties would each submit an offer to the independent arbiter,” reports the Senate’s website, “When choosing between the two offers the arbiter is required to consider the median in-network rate, information related to the training and experience of the provider, the market share of the parties, previous contracting history between the parties, complexity of the services provided, and any other information submitted by the parties.”
Consumers are to be given true and honest cost estimates.
The No Surprises Act seeks to empower patients by having them receive estimates that describe which providers will deliver their treatments, the costs of services and provider network statuses. The new legislative agreement also includes a long-term extension of expiring public health programs, including Community Health Centers, National Health Service Corps, Teaching Health Centers and Special Diabetes Programs.
“Consumers will be protected from surprise medical bills when they receive care in both emergency and nonemergency settings; the protections extend to out-of-network air ambulances,” summarizes Jack Hoadley, Katie Keith and Kevin Lucia on HealthAffairs.org, “As a result, patients will be protected from surprise bills in situations where they have little or no control over who provides their care.”
At Allegiant Experts, we have decades of experience evaluating medical bills.
In many court cases, we have helped to determine the usual and customary charges for providers in specific geographic areas and fair market value reimbursement for like providers in the same geographic areas.Maybe we can help you! Call us at 407-217-5831 or email us at info@allegiantexperts.com if you have healthcare questions. If we can’t help you, we’ll be sure to point you in the right direction!