The cost of care and services that a patient may receive is one of the murkiest areas of healthcare. There’s no shortage of mind-blowing stories of exorbitant bills that people have received of surprise bills after an emergency room visit, surgery, or even childbirth. This New Year’s brought the dawn of a new day and (hopefully) the end of surprise billing.
Everyone needs to be aware of the No Surprises Act that went into effect on January 1, 2022.
Here are some high-level highlights directly from the CMS site:
How does the No Surprises Act protect me if I have health insurance?
If you obtain your health insurance through an employer, the Health Insurance Marketplace, or have a health plan you purchased directly from an insurance company, the No Surprise Act will:
Ban surprise bills for emergency services, even if you get them out-of-network and without prior authorization.
Ban out-of-network cost-sharing for all emergency and some non-emergency services. You can no longer be charged more than in-network cost-sharing for these services.
Ban out-of-network charges and balance bills for care like emergency medicine, anesthesiology, pathology, radiology, neonatology that may be provided by out-of-network providers who work at an in-network facility.
Require that doctors and healthcare delivery organizations give patients an easy-to-understand notice explaining that getting care out-of-network could be more expensive and suggest options to avoid surprise bills. Patients need to know that they are not required to sign this notice or get care out-of-network.
Here’s a sample of a new form that you as a patient may see at your health care encounters, called the Surprise Billing Protection Form: https://www.cms.gov/files/document/notice-and-consent-form-example.pdf
What if I don’t have health insurance or am self-pay?
Beginning January 1, 2022, if you’re uninsured or you pay for health care bills out of pocket, you can request your doctors and health care providers to provide you with a “Good Faith Estimate” for the costs of your anticipated care. This Good Faith Estimate should be itemized and include details such as diagnosis and service codes and total expected charges.
Here’s a sample Good Faith Estimate: https://www.cms.gov/files/document/good-faith-estimate-example.pdf
Doctors and health care delivery organizations should offer additional support if patients need explanations over the phone or in person. Patients should keep Good Faith Estimates for their records and hold on to them to review against final billing. Should final billing amount to higher than $400 over the Good Faith Estimate, patients may be able to pursue disputing the charges by way of the provider-patient resolution process.
What if I have questions and need additional support regarding the No Surprises Act?
A No Surprises Help Desk is ready to answer your specific questions at 1-800-985-3059.
Support at the No Surprises Help Desk is available in languages other than English.
The No Surprises Help Desk can provide all pertinent information on the No Surprises Act in an accessible format, like large print, Braille, or audio, at no additional costs to patients and families.
Please share this with your communities. Patients & their families NEED to know about this!
Here’s some additional reporting to provide more context: