No Surprises Act Takes Effect Jan. 1

The federal No Surprises Act takes effect Jan. 1, 2022, and seeks to protect consumers for surprise medical bills. Among its provisions, the No Surprises Act:

  • Protects patients from receiving surprise medical bills resulting from gaps in coverage for emergency services and certain services provided by out-of-network clinicians at in-network facilities, including by air ambulances.
  • Holds patients liable only for their in-network cost-sharing amount, while giving providers and insurers an opportunity to negotiate reimbursement.
  • Allows providers and insurers to access an independent dispute resolution process in the event disputes arise around reimbursement. The legislation does not set a benchmark reimbursement amount.
  • Requires both providers and health plans to assist patients in accessing health care cost information.

Jefferson Community Health & Life is putting into place the required policies and provisions to comply with the act. JCH&L’s information can be found on the website at JCHealthandLife.org, and then under I want to …. View Surprise Billing/Good Faith Estimate Information.

Under the act, when a patient receives emergency care or gets treated by an out-of-network provider at an in-network hospital or surgical center, the patient is protected from surprise billing. Surprise billing may happen when a patient can’t control who is involved in his or her care – such as during an emergency or when a visit is scheduled at an in-network facility but is unexpectedly treated by an out-of-network provider.

The new provisions also allow patients to receive a Good Faith Estimate of the cost of particular medical procedures from health care facilities. Health care providers must provide an estimate of the bill for upcoming medical items and services to patients who don’t have insurance or who are not using insurance to pay for a service. The Good Faith Estimate would be given for the total expected cost of non-emergency items or services. This includes related costs, such as medical tests, prescription drugs, equipment and hospital fees. The Good Faith Estimate is given in writing at least one day before the medical service, or may be given before scheduling. If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

If you have questions about these new rules, call JCH&L at 402-729-3351.