The No Surprises Act:
Protections for Insured & Uninsured Patients
Posted on Monday, November 15, 2021
The bipartisan No Surprises Act will go into effect on January 1, 2022.
The No Surprises Act is intended to protect patients from surprise medical bills (when patients are unknowingly treated by out-of-network providers) and balance billing (when patients are charged for the remainder of what their insurance does not pay).1
Read on for an overview of the new rules and how this law affects both insured and uninsured patients.
Overview of the No Surprises Act
“Requirements Related to Surprise Billing; Part I,” an interim final rule issued July 1, 2021:
- “Bans surprise billing for emergency services” which “must be treated on an in-network basis without requirements for prior authorization.”1
- Restricts surprise billing for “non-emergency care from out-of-network providers at in-network facilities,”2 which protects patients who are not given the chance to choose an in-network provider.
- Restricts surprise billing for “air ambulance services from out-of-network providers.”2
- Extends protections from balance billing, which is already prohibited by Medicare and Medicaid, to “Americans insured through employer-sponsored and commercial health plans.”1
“Requirements Related to Surprise Billing; Part II,” an interim final rule issued September 30, 2021:
- “Details a process that will take patients out of the middle of payment disputes.”3
- Provides “a transparent process to settle out-of-network (OON) rates between providers and payers.”3
- Outlines “requirements for health care cost estimates for uninsured (or self-pay) individuals.”3
How Does the No Surprises Act Protect Uninsured Patients?
This law requires that providers or facilities inquire about patients’ insurance status when scheduling and “provide a good faith estimate of expected charges for items and services” to uninsured/self-pay patients (those who do not have benefits for an item/service under a health plan or who choose not to have a claim submitted to their plan for the item/service).4
CMS Administrator Chiquita Brooks-LaSure explained, “we are requiring health care providers and health care facilities to provide uninsured patients with clear, understandable estimates of the charges they can expect for their scheduled health care services.”3
If an uninsured or self-pay patient is billed for an amount “substantially in excess” ($400 or more) of the good faith estimate they received, they may be eligible for the “patient-provider dispute resolution process” to determine a payment amount. This process must be initiated within 120 days of receipt of the bill.4
In addition to instituting financial safeguards, the No Surprises Act can also improve healthcare access. As HHS Secretary Xavier Becerra stated, “No patient should forgo care for fear of surprise billing.”1 With these new rules in place, patients may be less likely to postpone or avoid needed healthcare due to concerns about the financial ruin that often comes from surprise medical bills.
Lowering Patients’ Healthcare Costs
The new protections established by the No Surprises Act can help lower both insured and uninsured patients’ out-of-pocket healthcare costs by sheltering them from unexpected and/or excessive medical bills.
EligibilityAdvocates can further reduce patients’ medical expenses by helping them obtain health coverage and/or financial assistance. Our Patient Advocates work one-on-one with patients to determine their eligibility for various insurance plans and benefit programs and assist them with the application process.
Additionally, we can help patients resolve their patient balances and understand their patient responsibility.
1 CMS (U.S. Centers for Medicare & Medicaid Services). “HHS Announces Rule to Protect Consumers from Surprise Medical Bills.” (2021). Retrieved from https://www.cms.gov/newsroom/press-releases/hhs-announces-rule-protect-consumers-surprise-medical-bills
2 CMS (U.S. Centers for Medicare & Medicaid Services). “Overview of rules & fact sheets.” (2021). Retrieved from https://www.cms.gov/nosurprises/Policies-and-Resources/Overview-of-rules-fact-sheets
3 HHS (U.S. Department of Health & Human Services). “Biden-Harris Administration Advances Key Protections Against Surprise Medical Bills, Giving Peace of Mind to Millions of Consumers Plagued by High Costs.” (2021). Retrieved from https://www.hhs.gov/about/news/2021/09/30/biden-harris-administration-advances-key-protections-against-surprise-medical-bills.html
4 CMS (U.S. Centers for Medicare & Medicaid Services). “Requirements Related to Surprise Billing; Part II Interim Final Rule with Comment Period.” (2021). Retrieved from https://www.cms.gov/newsroom/fact-sheets/requirements-related-surprise-billing-part-ii-interim-final-rule-comment-period