In December 2020, the No Surprises Act was signed into law as part of the Consolidated Appropriations Act. The act has far-reaching implications for anyone with a medical benefit plan, as it seeks to protect patients from surprise medical bills. In this blog post, we will take a closer look at the No Surprises Act and how it affects you as an employee covered under a medical benefit plan.
Surprise bills occur when you receive emergency medical care from a provider who is out of network, when you receive out-of-network care within an in-network facility or when an out-of-network provider is brought in without your knowledge. The No Surprises Act aims to prevent these bills.
The act achieves this by requiring that all emergency services and non-emergency services provided at an in-network facility or by an in-network provider be treated as in-network for the purposes of insurance coverage. This means that any out-of-network services you receive while being treated at an in-network facility will be covered by your insurance plan. Additionally, the act requires that patients only pay their in-network cost-sharing amount when receiving out-of-network care.
Furthermore, the No Surprises Act vastly improves transparency for patients by requiring health insurers to provide clear and concise information about their medical benefit plan network directories. All plan members must be able to access the latest directory information prior to any service. This includes the contact information of the provider, the type of medical service they offer, whether they are covered by insurance, and the cost and quality of care.
Lastly, the act aims to provide protection for patients undergoing scheduled elective procedures. Providers must provide a cost estimate to the patient at least 72 hours before the procedure. The estimate must include the expected cost and a list of providers involved, including the services and facilities provided. Should a provider change before the procedure, the patient must be notified, and a new estimate must be provided.
Examples of No Surprises Act may include anesthesiology, ambulance and emergency care. These authors continue to hear of individuals that receive invoices for thousands of dollars, assume they owe the money and pay. Just because you are billed by a provider does not mean you owe them this money. It is common to find that your insurance company was never even billed and you need to submit the charges for consideration. If you receive a bill that doesn’t seem right, call the number on the back of your ID card and inquire.
In summary, the No Surprises Act serves as a protection to members of medical benefit plans, ensuring that unexpected medical bills will not overwhelm them. Patients must no longer worry about being hit with surprise bills for out-of-network medical care. The new law promotes transparency in insurance plans, and it strengthens patients’ ability to make informed decisions about their medical care. Anyone with a medical benefit plan should be familiar with the No Surprises Act because, at one point or another, each plan member would have been affected by hidden providers that they have no control over. With this new law, they can have peace of mind should they ever need medical attention.
