A new document designed to clarify the No Surprises Act regulations addresses some medical billing issues but leaves other important guidance to be determined later.
The No Surprises Act (NSA) is a part of the Consolidated Appropriations Act of 2021 (CAA). It provides federal protections to patients who get bills for receiving care out of network — in circumstances when they did not know the service was out of network. One of the key points of the NSA provisions is removing the patient from disputes between payers and providers.
A study by the Office of the Assistant Secretary for Planning and Evaluation Office of Health Policy found that surprise bills occur frequently and can have a negative effect on a person’s budget. “On average, 18 percent of emergency room visits by people with large employer coverage result in one or more out-of-network bills and nearly 20 percent of patients undergoing in-network elective surgeries or giving birth in a hospital received surprise bills,” according to the study.
Surprise bills averaged more than $1,200 for anesthesia; $2,600 for surgical assistants; and $750 for childbirth. President Donald Trump signed the NSA as part of the Consolidated Appropriation Act of 2021 on Dec. 27, 2020. Most sections of the legislation went into effect on Jan. 1, 2022, and the Departments of Health and Human Services, Treasury and Labor have responsibility for issuing regulations and guidance to implement several of the provisions.
The No Surprises Act requires providers and health plans to assist patients in finding health care cost information. The NSA protects patients from receiving surprise medical bills when there are gaps in coverage for emergency services and certain services provided by out-of network clinicians at in-network facilities, including by air ambulances.