Unexpected medical bills have been a major affordability concern for millions of American families for decades, so much so that it can even make some patients forgo care. To ensure that no American ever takes such a step for fear of increased financial hardships, No Surprises Act has been framed. <\/p>\n\n\n\n
The Act, which takes effect January 1, 2022, has multiple provisions to keep consumers harmless from the cost of unanticipated out-of-network medical bills. These provisions strive to provide patients with financial peace of mind while seeking emergency care and safeguard them from unknowingly accepting out-of-network care and subsequently incurring surprise billing expenses. <\/p>\n\n\n\n
In the run-up to the January rollout, the Biden administration this month came out with \u201cRequirements Related to Surprise Billing; Part I,\u201d an interim final rule that will restrict excessive out of pocket costs to consumers stemming from unanticipated bills. <\/p>\n\n\n\n
In this first of a two-part blog series, we are sharing an overview of the key provisions of the upcoming Act, how this rule will help, and who stands to benefit. <\/p>\n\n\n\n
The Centers for Medicare & Medicaid Services (CMS) has stated that the first rule implements several important requirements for group health plans, group and individual health insurance issuers, carriers under the Federal Employees Health Benefits (FEHB) Program, health care providers and facilities, and providers of air ambulance services. <\/p>\n\n\n\n
Provisions for Greater Protection<\/strong> <\/p>\n\n\n\n Key Benefits<\/strong> <\/p>\n\n\n\n If a particular health plan provides or covers benefits for emergency services, this rule requires these services to be covered without any prior authorization and regardless of whether a provider or facility is in-network. <\/p>\n\n\n\n The Act also protects people from excessive out-of-pocket costs by limiting cost sharing for out-of-network services to in-network levels, requiring cost sharing for these services to count toward any in-network deductibles and out-of-pocket maximums, and prohibiting balance billing under certain circumstances.\u202f <\/p>\n\n\n\n The protections in this rule apply to most emergency services, air ambulance services from out-of-network providers, and non-emergency care from out-of-network providers at certain in-network facilities, including in-network hospitals and ambulatory surgical centers. <\/p>\n\n\n\n Additionally, this rule requires certain health care providers and facilities to furnish patients with a one-page notice on the requirements and prohibitions applicable to the provider or facility regarding balance billing and any applicable state balance billing prohibitions or limitations. It also has provisions to inform patients about how to contact appropriate state and federal agencies if they believe the provider or facility has violated the requirements described in the notice. <\/p>\n\n\n\n Who Benefits and Who Doesn\u2019t\u202f<\/strong> <\/p>\n\n\n\n The surprise billing protections apply to those who get the coverage through their employer (including a federal, state, or local government), or through the federal Marketplaces, state-based Marketplaces, or directly through an individual market health insurance issuer. <\/p>\n\n\n\n The rule does not apply to people with coverage through programs such as Medicare, Medicaid, Indian Health Services, Veterans Affairs Health Care, or TRICARE. These programs already prohibit balance billing. <\/p>\n\n\n\n Conclusion:<\/strong> A strict regulation to shield patients from a sudden financial burden stemming from surprise medical bills was long-overdue. Unexpected medical bills and balance bills affect many Americans, particularly when people with health insurance unknowingly get medical care from a provider or facility outside their health plan\u2019s network. This can be common in emergency situations, where people usually end up at the nearest health facility without considering their health plan\u2019s network. Patients in emergency situations may have little or no choice when it comes to who provides their care. Billing patients for services despite their health insurance covering emergency care is neither justifiable nor acceptable. <\/p>\n\n\n","protected":false},"excerpt":{"rendered":"