6 Things Everybody Needs To Know About the No Surprises Act

According to the American Medical Association, people in the U.S. spend more than
$4 trillion on healthcare services annually. This figure may sound exaggerated, but if you’ve sought out medical treatment recently, you know just how costly healthcare can be. You also know that the bill you receive may contain costs that you didn’t expect. If you’re a patient or health insurance broker, you need to understand how the No Surprises Act may change this.



1. A Health Insurance Broker Can Help You Find the Right Coverage

There are many factors that impact how much a patient pays for medical services. One of the most important of these is the health insurance policy that they carry. Policies that include coverage for a bigger network, for example, tend to incur lower costs for patients. Similarly, a
health insurance policy that offers generous coverage for prescription medication can reduce the out-of-pocket costs you face. An insurance broker is a valuable resource for finding the right coverage.

2. Balance Billing Will Be Banned

One of the most important aspects of the No Surprises Act is its ban on balance billing. Balance billing refers to the practice of charging patients for out-of-network care after collecting partial coverage from an insurer. The act prohibits this action for patients who receive emergency services. The bill dictates that providers cannot issue balance billing for any of these services:

AnesthesiologyPathologyDiagnostic testingSurgical careRadiology

The bill further requires insurers to treat all emergency services as an in-network expense without prior authorization. This eliminates many of the surprises that can emerge after receiving emergency care, and it allows a health insurance broker to offer better coverage options, too.

3. Out-of-Network Billing Now Requires Patient Consent

Although the No Surprises Act shields patients from out-of-network costs for emergency services, patients who seek standard care outside their insurer’s network will still have to contend with increased costs. The act aims to mitigate the impact of these expenses, though, by ensuring that patients understand the cost before they seek services.

Out-of-network providers will now have to obtain written consent from patients in order to issue balance billing. If a patient does not waive their exemption from balance billing, though, the provider is entitled to refuse service — even if a health insurance broker advises patients that their care is covered.

4. Patients Have the Power to Dispute Their Bills

Despite all of the aforementioned protections that the No Surprises Act provides, there will still inevitably be charges on bills that patients don’t expect and don’t agree with. When this happens, the bill allows patients to dispute the cost and request that it be removed. This relies on the provider’s good-faith estimate for the cost of services, which a patient can request at any point during treatment. If the bill is then more than $400 over the estimate, they can
submit a dispute or look for a new plan with a health insurance broker.

5. Providers and Insurers May Enter an Arbitration Agreement

Insurers also have the ability to dispute charges from medical providers. If an insurance provider receives a bill that includes contested expenses, for example, the insurer will enter an arbitration process with the healthcare provider. Patients are not involved in this process, and it typically does not affect the amount that they pay. According to research,
over 157,000 health insurance claims have entered arbitration since the No Surprises Act went into effect. This benefits every patient and health insurance broker who wants to ensure that medical providers bill fairly.

6. There Are Some Exceptions to the No Surprises Act

The No Surprises Act has massively improved medical billing practices for millions of patients and providers. It hasn’t eliminated the issue of surprise billing completely, though, as there are still some exceptions to the protections that it provides. While the bill does extend coverage to air ambulances, ground ambulances are exempt from coverage. Similarly, while care in a hospital or emergency room is covered, care in a clinic or urgent care facility is not. Patients should consult with their health insurance broker to determine their coverage.

7. Partnering With a Health Insurance Broker May Minimize Medical Costs

The No Surprises Act is set to make a major difference in the lives of many Americans. Too many people are saddled with medical debt, exorbitant bills, and unnecessary stress simply because they needed emergency medical care. Thanks to this new policy, you don’t have to worry about receiving a shocking bill after treatment — you can focus on your recovery instead.

Partnering with a health insurance broker can further ensure that your coverage shields you from unexpected expenses. Patients who want to simplify their healthcare can trust Sackett & Associates Insurance Services to help them do so. For more information on how to get a coverage quote, reach out to us at (707) 823-3689 or
contact us online.