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.