The No Surprises Act was created to protect patients from unexpected medical bills. It went into effect on New Year’s Day 2022. The federal law has not actually reduced health care costs at high out of-network rates and certain forms of balance billing for provider charges that are not covered by insurance. The provisional report […]

The No Surprises Act was created to protect patients from unexpected medical bills. It went into effect on New Year’s Day 2022. The federal law has not actually reduced health care costs at high out of-network rates and certain forms of balance billing for provider charges that are not covered by insurance.

The provisional report card for the new law is mixed.

Insurance companies tout the amount of unexpected bills the law prevents, but are concerned about the burden of claims disputes.

Analysts believe that the law was written to protect consumers, but have not yet seen enough data to make a decision.

Morning Consult’s June poll found that health care consumers rate lower. According to the poll, one in five respondents claimed that they received an unexpected medical bill during the first half year. It’s not clear how many surprises, if any, should have been prevented by the No Surprises Act’s limited protections.

It is difficult to determine if the law is being actually implemented. The issue is: Are consumers getting surprise bills?

Expert on the Ground

director of health care campaigns at U.S. PIRG

According to a statement from AHIP, an industry trade group, the law stopped more than 2,000,000 potential surprise bills reaching commercially insured patients between January 1 and February. Analysts still remain skeptical.

“It is very difficult to determine whether the law has been implemented because the issue was: Are consumers and not receiving surprise bills?” says Patricia Kelmar (director of health care campaigns at U.S. Public Interest Research Groups a national federation consumer advocacy organizations).

Low awareness by consumers of the new protections only adds to observers’ doubts. According to Morning Consult, only 16% said that they had read, seen or heard anything about the No Surprises Act in June. If providers or insurers don’t comply, consumers who don’t understand the law don’t know what their rights are.

Further questions arise from the complexity of the law, primarily because of certain exceptions that allow out-of-network billing and balance billing. Loren Adler, associate Director of the University of Southern California’s Schaeffer Initiative for Health Policy, says that not all surprises bills fall under the NSA. For example, Urgent care doesn’t get the law’s protections.

Does the new law work?

The effectiveness of the new consumer protections may not be as well assessed yet, and the federal agencies don’t release statistics. Requests for data regarding consumer complaints about violations of the No Surprises Act were not answered by the Department of Health and Human Services or the Centers for Medicare & Medicaid Services (or CMS) and the Department of Health and Human Services.

“It’s hard to know but I gather that mistakes are made from time-to-time,” says Karen Pollitz (a senior fellow and codirector of the Program on Patient and Consumer Protections, KFF), a news and policy organization in health care. “If there is a mistake, the consumer must figure out what to do next span>

Others are pleased with the overall performance of the law. Adler states that “The No Surprises Act works pretty well.” It doesn’t solve every problem in the healthcare system and there are still surprise bills span>

How the law should protect you

The No Surprises Act provides the most protections in an emergency room. This is where patients are most vulnerable.

Pollitz states that “most surprise medical bills will involve emergency services.” There are no exceptions in the ER. Everyone who touches you or your images must first send their claims directly to your insurance company before they send you a billing. This will allow you to determine your cost-sharing percentage. For every .”

Hospitals cannot bill for post-stabilization services. These services are provided by any department following the initial emergency care.

However, the new law protects you from out-of-network or balance billing for non-emergency care. There are some exceptions to this rule. If your primary care physician is in-network, and orders tests from an outside-of-network laboratory, the lab could still balance bill you for any difference in rates.

If you don’t have insurance, the No Surprises Act provides different consumer protections. Kelmar states that if you are paying out-of-pocket or don’t have insurance you can get an estimate in advance. This gives consumers the chance to plan and push back financially for their medical treatment .”

You should think carefully before signing a waiver of your rights pursuant to the No Surprises Act. You may still be able to appeal if you sign the waiver and regret it later. Patients cannot be asked to waive their protections by providers if they aren’t in-network. This applies to unexpected medical needs, as well as certain ancillary services.

What should you do if you get an unexpected bill

What should you do if a provider fee is significantly higher than your plan’s coverage within-network? It’s possible that you need assistance in determining the reason behind the charge. Kelmar states that this could be an error or providers trying to make a profit by sending balance bills.

Call CMS’s No Surprises Help Desk at 800985-3059 to learn how you can file a complaint or dispute in any state. English and other languages are available for assistance. Pollitz states that CMS is supposed to determine who should solve each complaint.

CMS offers two options for consumers who are not happy with provider bills.

  • You can file a complaint about health insurance charges.

  • You can contest a bill

Your state has chosen as its enforcement method under the No Surprises Act.

  • States may enforce the law by themselves.

  • Other states have given up enforcement to federal agencies

  • Other states cooperate with federal agencies to enforce the law.

The No Surprises Help Desk will be able tell you how enforcement works within your state.

Adler proposes a different start point: “If you receive an unexpected bill from any provider, your first recourse should be your insurer. They are at risk for losing their license if it isn’t followed.”

Pollitz suggests another avenue: State Consumer Assistance Programs. These are federal or state agencies that provide assistance to consumers in insurance matters. She says that consumers should contact anyone they feel can help them.