What I Need to Know about the No Surprise Act

When a Healthcare Consumer receives a bill from a healthcare provider one of the first questions to ask is whether it is a surprise bill.  The following will guide you through the answer:

What Is the No Surprises Act?

  • The No Surprises Act provides patients with protection from surprise medical bills under certain circumstances. It also mandates transparency regarding healthcare costs and holds patients liable for in-network cost-sharing amounts only.
  • Additionally, the legislation allows healthcare providers and insurers to negotiate reimbursement separately while insulating the patient from that process. It also includes a provision for an independent dispute resolution process if necessary. The Departments of Health and Human Services (HHS), Treasury, and Labor are tasked with issuing regulations and guidance to implement the No Surprises Act, most of which went into effect on Jan. 1, 2022.

KEY TAKEAWAYS

  • The No Surprises Act, part of the Consolidated Appropriations Act of 2021, forbids patients from receiving surprise medical bills when seeking emergency services or certain services from out-of-network providers at in-network facilities.1
  • Holds patients liable for their regular in-network cost-sharing amount only.
  • Allows providers and insurance companies to negotiate reimbursement separately including through an independent dispute resolution process.
  • Requires providers and health plans to help patients access accurate healthcare cost information.
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