More information regarding the Patient Rights under the No Surprises Act by the Centers for Medicare Medicaid Services (CMS) by Kevin Harrington

The people covered under insurance and those who are not covered by insurance now have protection from receiving a bill from a provider that they did not have any idea of how much the bill would actually be from the provider.

This new act called the “No Surprises Act” will be instrumental in reducing the occurrences of surprise medical bills by providers moving forward. According to the Human Services Secretary Xavier Becerra no patient or responsible party should worry about going bankrupt after an illness. There has been misconception by consumers that when they are in an employer-sponsored health plan that they would be insulated from high out-of-pocket expenses related to the healthcare they receive. This misconception can be expensive as some of the emergency services one receives ended up creating a considerable amount of out-of-pocket expenses for healthcare consumers. These surprise bills received from a provider could sometimes be as high as 7-10 times higher than those with coverage for the encounter in the Emergency Department.

Historically, there are varying degrees of protection among the states, and even though they are looking to protect the patient in some way, the states are experiencing many limitations in protecting the patients. The No Surprise Act that was brought forth by the Biden-Harris Administration have put forth efforts to stop providers from balance billing the patient for services rendered. Also, the Biden-Harris Administration recently added some features for resolving disputed claims so they will not end up with a huge surprise bill in the future.

According to CMS, this bill provides special protections from surprise medical billing that includes:

·        Establishing an independent dispute resolution process to determine out-of-network payment amounts between providers (including air ambulance providers) or facilities and health plans.

·        Requiring good-faith estimates of medical items or services for uninsured (or self-paying) individuals

·        Establishing a patient-provider dispute resolution process for uninsured (or self-paying) individuals to determine payment amounts due to a provider or facility under certain circumstances.

·        Providing a way to appeal certain health plan decisions.

For most of us, this will be a great savings for when we receive healthcare services in the future. More importantly, this will also help to reduce health insurance premiums for healthcare consumers.

For providers, they will need to be more adept in their billing processes, from registration to claims submission. It will require more transparency from the provider’s side of the equation, but should end up making the deliver of healthcare services more straightforward.

 

Reference

Centers for Medicare. (2021). Overview of rules & fact sheets. Retrieved from: https://www.cms.gov/nosurprises/policies-and-resources/overview-of-rules-fact-sheets