As many as 9 million surprise medical bills have been prevented since January 2022 due to the impact of the No Surprises Act, according to a new report.
This is the first data that indicates the law, aimed at eliminating surprise medical billing for insured patients getting emergency treatment, is working. The number of claims subject to protections of the law have far exceeded the federal government’s initial prediction, the report by AHIP Health Policy & Markets Forum and the Blue Cross Blue Shield Association found.
If you have not made your employees aware of this groundbreaking law, you should, as Americans are tagged with billions of dollars a year in surprise bills when they go out of network, even if they don’t know it.
Often these bills come after going to an in-network hospital but either the doctor, the lab or the anesthesiologist were out of network.
Surprise billing is also common in medical emergencies, when an ambulance takes a patient to the closest ER – and frequently at a hospital that’s not in the patient’s network. The patient is normally in no condition to check his or her plan for in-network providers.
The No Surprises Act
Beginning on Jan. 1, 2022, the No Surprises Act banned surprise medical billing in most instances. The purpose of the law was to reduce surprise medical billing for insured patients receiving emergency treatment.
However, the law provides patients additional rights in some non-emergency situations, as well.
To help control your employees’ medical costs, it’s a good idea for plan sponsors to make sure workers and their families understand how the law works, so they can assert their rights under the act.
The act prohibits in-network hospitals and other providers from billing patients for any out-of-network charges for emergency services. The most the in-network provider can bill the patient for is their plan’s maximum in-network cost-sharing amounts.
So, if a patient is admitted to the ER and they must have an emergency surgery, and the surgeon or anesthesiologist is out of network, the hospital cannot bill the patient any more than they would have billed them had the surgeon or anesthesiologist been in the plan’s network.
Patients must still pay their deductible, copays and co-insurance amounts.
Providers cannot bill patients with insurance for anything beyond that.
Patients who are uninsured, or who are self-paying for care scheduled in advance (i.e., non-emergency care), are entitled to a “good faith estimate” from their providers.
If the patient gets a bill for anything more than that estimate, plus $400, they have 120 days from receipt to contest the bill.
Some providers may ask your employees to sign a document that waives their rights under the law. However, the No Surprises Act prohibits waivers for any of these services:
- Emergency care
- Unforeseen urgent medical needs during non-emergency care
- Ancillary services
- Hospitalist charges
- Assistant surgeon charges
- Out-of-network provider services when no in-network alternative is available
- Diagnostic services.
Key points for covered employees
- You are not required to waive your rights under the No Surprises Act.
- You are not required to use out-of-network providers. You can seek non-emergency care in-network.
- Your plan must cover emergency services without requiring preauthorization.
- Your plan must cover emergency services by out-of-network providers.
- Your plan must apply any amounts you pay for emergency or out-of-network services towards your deductible and out-of-pocket limits.
If you’ve been wrongly sent a surprise medical bill, visit https://www.cms.gov/nosurprises.