If there is one aspect which all of us dread when going into a hospital is not the needles or drips, but it is the medical bill which would tag along in the end. Medical provision in a lot of countries is expensive, however, while the bills are expensive, the worst part comes in the form of surprises medical bills.

However, do you know the Surprise Medical Act can protect you from paying all such bills, which might not be shown upfront? Yes, you heard us right! Are you interested and want to know more about the No Surprises Act? This article has you covered.

What is the No Surprises Act?

The No Surprises Act is an aspect that will protect the patients walking out of the hospital from paying any surprise medical bills. However, this act is only applied under certain conditions. The No Surprises Act also makes it mandatory for hospitals to showcase transparency regarding healthcare costs. Moreover, it will also hold patients liable when it comes to in-network cost-sharing amounts only.

While all this is great, this legislation also allows healthcare providers and other insurance companies to negotiate when it comes to the reimbursement cost separately when they are releasing the patient from the process. This act is regulated, and the Department of Health and Human Services implements its guidance. Most of the No Surprises Act went into effect on Jan 1, 2022.

Understanding the No Surprises Act

While you might think that the No Surprises Act has been present in the medical insurance world for a long time, this act, in fact, only went into effect at the beginning of 2022. Since then, it has saved multiple individuals from paying bills that they did not know about. Don’t understand what we mean?

Well, this act or bill makes it illegal for health providers or insurance companies to bill patients for things which are more than the in-network cost-sharing price. This means that if the patient did not know that the cost which has been added to their bill comes from an out-of-network provider, then legally, they are not bound to pay it.

Moreover, certain non-emergency out-of-network ancillary services are also not billed if they exceed the in-network cost-sharing, irrespective of whether the patient was informed or consented about the service. These services generally include pathology, radiology, neonatology, anesthesiology, and lab services.

All of this generally means that the No Surprises Act requires healthcare providers to initiate or implement out-of-network health plans if they fall into in-network when they determine the amount they will charge the patients for the services.

Requirements for the No Surprises Act

You must be wondering if all individuals benefit from the No Surprises Act and whether the act holds some requirements. Well, you stand correct on this forte. This act, in fact, does have a few essentials and restricts surprise billing only to:

• Emergency patients who are under the employer or individual health plans.
• The air ambulance services which an out-of-network provider provides.
• Any non-emergency health service which an out-of-network provider provides for an in-network facility.
• Post-stabilization care is provided at an out-of-network facility until the time when you can transfer the patient to a different or in-network facility.
• Out-of-network services are delivered at or ordered from an in-network facility until and unless the provider follows the notice and consent process.

If you are wondering what this notice and consent process is, then let us tell you that this process makes it mandatory for the provider to inform the patient about the out-of-networking services which they will be provided at least 72 hours before they are delivered,

This provision enables the patient to choose an out-of-network provider through which they can make such a choice; however, you should also understand that this rule does not apply to specific fields of practice known as the ‘no exception’ group.

Impacts of the Act on Physicians

Given that the No Surprises Acts works so much in favor of the patients, we understand by this point that you must have understood that it does have an impact on the physicians, right? If you are someone who is wondering about these impacts, then we have this aspect covered for you as well.

The No Surprises Act restricst the health care providers from any form of surprises billing. Hence, it also restricts the number of out-of-network physicians who are generally allowed to charge the patients.

So, as much as it protects the patients from paying extra costs, which they did not know about, it limits practitioners that have smaller outfits from diving deeper into the dispute resolution option. Therefore, many physicians simply settle on the in-network rates due to the time and amount an alternative attribution process takes.

Wrapping Up!

We all dread the medical bills put upon us when we leave the hospital. However, the recent introduction of the No Surprise Act has saved multiple people from the scare that medical bills bring. If you heard about this act and wanted to know what it is and all the requirements it sits nicely on, then we hope this article was helpful for you. Let us know whether you have benefited from this act at a time in your life.