Last December, the Consolidation Appropriations Act (CAA) was signed into law. At $2.3 trillion, it was the largest spending bill ever enacted. It was also the longest bill ever passed by Congress.
The bill contained COVID-19 relief, assistance to business and private citizens, and an array of unrelated items Congress typically tucks into bills like this. It also included a section known as the No Surprises Act, which deals with surprise healthcare billing.
Surprise bills often occur when a person receives care in an in-network facility by an out-of-network provider. For example, going to the ER at a in-network hospital, but being treated by doctors belonging to an out-of-network organization. You receive your bill, and surprise! It’s much higher than you expected.
I once went to an in-network hospital for surgery and received an out-of-network bill as the surgical room where the procedure was performed was considered out-of-network. I was more than surprised – shocked would be more accurate! (I challenged that bill, and the hospital eventually dropped the charges.)
The No Surprise Act addresses this billing procedure by requiring changes that apply to individual and group health plans beginning in January 2022. Here are the salient points:
- Non-network charges cannot be billed for emergency services.
- Insurance companies must keep their provider directories up to date and verify accuracy every 90 days. Plus, they must respond within one day to consumers inquiring as to a providers’ network status.
- Health plans must provide comparison tools, both phone and internet, for customers and in-network providers, so they can compare cost-sharing amounts for covered services.
- Insurance companies must provide advanced Explanations-of-Benefits (EOBs), within one to three business days, upon receiving a request. This will allow insureds to see a good faith estimate of services prior to a procedure.
- Providers must also provide good faith estimates for services they offer to their patients. (I’ve asked for this information, and it has been ridiculously frustrating to get an answer.)
- Insurance companies must notify their insureds when a provider/facility leaves the network, and provide transitional care, at in-network rates, for up to 90 days.
- New physical and digital ID cards must be issued for 2022 showing the plan’s deductible and out-of-pocket maximum limits.
Insurance companies are scrambling to get ready to comply with the No Surprise Act. Providers are gearing up too. This legislation is much needed, in my opinion. No other industry operates behind pricing opaqueness like healthcare. Let the light shine in.
