Federal No Surprises Act Explained

  • 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 to know?

    • Premera 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.

     

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