The “No Surprises Act” and Health Care
By: Natalie Burch, Masters Level Intern
The policy named the “No Surprises Act” (NSA) is a policy that was enacted January 1, 2022 for all healthcare and medical facilities. This requires all of these facilities to provide a good faith estimate of costs that the client can expect so that clients are no longer hit with high medical bills after receiving services. This good faith estimate only needs to be provided to individuals who do not have insurance or are out of network with the provider they are going to see.
This policy attempts to address the high medical bills that patients receive after seeing the service provider. These bills can be hundreds or thousands of dollars and a financial burden for individuals and families. Pollitz states that 1 in 5 emergency room visits, patients are inadvertently given a provider that is not within their network (Pollitz, 2021). Additionally, she states that, “between 9% and 16% of in-network hospitalizations for non-emergency care include surprise bills from out-of-network providers (such as anesthesiologists) whom the patient did not choose,” (Pollitz, 2021). This is a major issue for patients who are looking for care, especially within their network, and receive out of network costs. This issue is not as small as one would hope, however. Of the 329.5 million people living in America, 300 million of those individuals are estimated to have health insurance. Pollitz states that the United States government predicts that the No Surprises Act (NSA) will, “apply to about 10 million out-of-network surprise medical bills a year,” (Pollitz, 2021). This equates to roughly 3.3% of the insured population and 3% of the entire population.
Therefore, the No Surprises Act aims to do exactly what its name implies, eliminate surprises specifically in billing after services have been rendered. This policy works in several ways to protect the consumer. The first of which is by, “requiring private health plans to cover these out-of-network claims and apply in-network cost sharing,” (Pollitz, 2021). Additionally, the No Surprises Act, “prohibit[s] doctors, hospitals, and other covered providers from billing patients more than in-network cost sharing amount for surprise medical bills,” (Pollitz, 2021). In addition to these financial restrictions, it also requires the medical facility to provide an estimated cost of services for out-of-network providers.
On a federal implementation level, lawmakers are communicating with stakeholders (KEith, et al., 2021) and include a $10,000 fine per consumer who is not provided with an NSA (Pollitz, 2021). However, it is not clear who mandates this and collects fines if it were to occur.
On a personal level, Inner Courage Counseling aims to provide the NSA good faith estimate to clients prior to booking them with the therapist they’ve requested. This is then filed in their file after providing written notice to them. This hopefully has helped clients tremendously in understanding their benefits including their deductibles. This helps them to make an informed decision about whether this mental health service is within their budget or if they need to look at reduced cost options such as seeing an intern.
With this understanding comes the power to make informed medical decisions, both for your physical and mental health. Navigating through insurance policies can be daunting and difficult, so being educated is the first step to taking control!
References
Keith, K., Hoadley, J., & Lucia, K. (2021, July 6). Banning surprise bills: Biden administration issues first rule on the no surprises act: Health Affairs Forefront. Health Affairs. Retrieved from https://www.healthaffairs.org/do/10.1377/forefront.20210706.903518/
Pollitz, K. (2021, December 10). No surprises act implementation: What to expect in 2022. KFF. Retrieved from https://www.kff.org/health-reform/issue-brief/no-surprises-act-implementation-what-to-expect-in-2022/
Study confirms effectiveness of no surprises act. Healthcare Purchasing News. (2022, May 30). Retrieved from https://www.hpnonline.com/regulatory/article/21269323/study-confirms-effectiveness-of-no-surprises-act