Don’t Be Surprised By The No Surprise Act!

Posted by donna@healthlawcenterplc.com in Dec, 2021

The federal No Surprise Act goes into effect on January 1, 2022.  The intent of the Act is to protect patients from unanticipated medical bills as a result of gaps in coverage for emergency services and certain services provided by out-of-network health care providers at in-network facilities.  Also, licensed health care providers and facilities, regardless of any insurance gaps and even if a patient has no insurance or is self-pay, are required to provide cost estimates for health care services.  Mental health services are included in the definition of health care services.

There are three key components of the Act.  First, healthcare providers and facilities may be prohibited from balance billing a patient (billing the patient for the difference between what is claimed and what the health plan pays).  Second, for uninsured or self-pay patients, a licensed healthcare provider and facility must provide a cost estimate for health care services if the patient requests an estimate and when a patient schedules an appointment for health care services.  Lastly, the Act provides for a dispute resolution process between health plans and healthcare providers / facilities for insured patients claims and different dispute resolution process between a healthcare provider / facility and a patient who is uninsured or self-pay.

To determine if and to what extent you are subject to the No Surprise Act you may get more information at:  https://www.cms.gov/nosurprises  You may also contact Donna J. Craig, RN,  JD at The Health Law Center, PLC for more information.