What You Didn't Know About the No Surprise Act
A Look at the No Surprise Act with a Benefit Risk Advisor.
By Chris Gertz
The No Surprises Act took effect on January 1, 2022. This act aims to prevent surprise medical bills for individuals who receive services from out-of-network providers or facilities. It specifically targets situations where individuals didn't have the chance to choose their provider or where out-of-network providers are involved in an in-network facility.
The Act offers several protections for consumers:
1. It bans surprise bills for most emergency services, even if out-of-network providers or facilities provide them.
2. It prohibits out-of-network cost-sharing that exceeds what would be required for in-network services. This means individuals cannot be charged more than the in-network cost-sharing amount.
3. It prevents out-of-network providers from balancing billing for certain additional services, such as radiology.
Insurance carriers and providers must collaborate to determine the appropriate payment for these services. If they can't agree, a certified IDR facility or federal independent dispute resolution process steps in to review the claims and determine the payment amount. Providers must accept the payment determined through this process.
The Act has two versions and processes:
The Federal Commercial Surprise Bill, which safeguards Self-Funded Plans and employers, and the State Commercial Surprise Bill, which protects Fully Insured Plans, MEWA plans, and nonfederal government plans.
The primary goal of this Act is to shield consumers in emergencies where they have no control over the providers they see. If you have any questions about your company's benefit plan, please don't hesitate to call us here at Hummel Group.
