On December 27, 2020, the No Surprises Act was signed into law. This law eliminates the large, surprise medical bills that patients often received after sugeries and emergent care from providers who cared for them who were not included in their insurance’s network.
This act addresses many issues in healthcare that were making life difficult for patients. While we’ll have to wait until 2022 to see this new law enforced, it is encouraging to know that the future of healthcare is looking brighter.
The No Surprises Act includes:
Patient cost-sharing protections
For the following medical services, a patient will not be forced to pay more than what they would have to pay if the service was “in-network” with their insurance:
- Emergency services
- Air-ambulance rides (ground ambulance rides are excluded from this act)
- Emergency room visits and procedures
- Non-emergency services
- Services provided by providers who are often not “in-network” with insurance providers, such as anaesthesiologists, radiologists, pathologists, etc.
The Act allows for voluntary exceptions to surprise medical bill protections, but only if a patient understands and agrees to use an out-of-network provider. For example, if a patient wants to see an out-of-network doctor, the patient can forgo the protections and be charged a balance bill from their insurer. This is because the medical service and accompanying bill would not be considered a “surprise” to the patient.
This act’s primary purpose is to remove the patient from the middle of payment disputes between providers and insurers. While the act doesn’t establish a benchmark payment rate, it does establish expectations and guardrails for providers and insurers to resolve payment disputes. For example, insurers and providers will have 30 days to engage in private, voluntary negotiations to resolve the payment dispute. If negotiations are not successful, either the insurer or the provider may, within four days, request independent dispute resolution, which will be established by the federal government. If there is no settlement and no request for arbitration, the provider is expected to accept the insurer’s amount.
Transparency (Advance Explanation of Benefits)
The legislation establishes a rule that databases should be built that contains a collection of all-payer claims paid. It also requires providers to give uninsured patients an estimate of their costs before the service is delivered.
Enforcement of the No Surprises Act and the settling of payment disputes is dependent on the states, and if the federal government has to get involved in arbitration, it will charge a $10,000 fine.
The No Surprises Act is designed to protect and benefit patients, who are often lost in payment disputes between providers and insurers. The Redde software empowers providers to give estimates of healthcare costs, and makes it easy and simple for patients to pay their bills.
For more information on the No Surprises Act, you can check out these resources below:
If you’d like to hear more about how Redde can help you comply with the No Surprises Act, and help increase your patient revenue through a mobile patient financial experience, you can contact us at firstname.lastname@example.org, or click the contact us button below.