October 21, 2021
The federal No Surprises Act is a new law that aims to reduce unexpected medical bills for patients. Taking effect January 1, 2022, it’s part of the Consolidated Appropriations Act, a $2.3 trillion spending bill that also includes stimulus relief for the COVID-19 pandemic and other provisions.
Who does this impact?
- Individual plans (state and federal exchanges) and group plans including the School Employees Benefits Board (SEBB) Program and the Federal Employee Program (FEP).
- All health insurers in the United States and covers all providers and facilities in the United States.
- Medicare Advantage members aren’t included as they’re already covered by a clause through the Centers for Medicaid and Medicare Services.
What’s included?
The No Surprises Act includes the following requirements:
- Prohibits balance billing of patients when out-of-network (OON)/non-contracted emergency care is received
- Includes certain ancillary services provided by OON providers at an in-network facility
- Requires a patient’s informed consent when services are provided by an OON provider
- Requires that health plans verify the accuracy of provider information included in the plan’s directory at least every 90 days
- Requires providers to respond every 90 days with updated directory information
- Includes a dispute resolution clause in the event an OON provider and the health insurer can’t agree on payment
- Requires providers to submit a good faith estimate to the health plan prior to any scheduled patient visit
What else do I need toknow?
- Premera/LifeWise is working through all the information and will be ready to implement the sections of the bill as required by the No Surprises Act timeline.
- Implementation dates vary from January 1, 2022, to January 1, 2023, depending on rules.
- In future issues of Provider News, we’ll dive into the details, including what it means to you and how we’ll be implementing the requirements.