Multi-Part COVID Relief and No Surprises Act Legislation Signed into Law by President Trump. The Consolidated Appropriations Act of 2021 includes COVID-19 Relief & Stimulus Payment as well as a balance billing No Surprises Act.
We are all happy to see that there will be funding available soon for COVID-19 from the Federal Government. $900 Billion in COVID-19 relief includes $600 payments to individuals. Although it may not be the amount many were hoping for, this funding with be helpful to start.
But did you realize that there was a second part of this bill? Balance-billing has been a huge issue for many years. Over the years I have had countless situations come up when members end up “Out-of-Network” in an emergency and get balance billed.
What is Balance Billing?
An Insurance company has a set payment schedule for certain procedures. This is generally negotiated between the carrier and the provider once they are on contract. When a member ends up out of network, there is no contract in place, and the carrier will not pay Full Billed Charges to the provider. So, the provider bills the difference to the member.
How Did I End Up Out-of-Network?
Perhaps you were traveling, had a life-threatening emergency and went to the nearest hospital that happened to be out of network. Perhaps you were at a participating facility, and a doctor covering surgery, or the ER wasn’t contracted. Or, maybe the Ambulance or Air Ambulance that took you to the hospital was out of network? Most of the time members try to stay In-Network, but occasionally, through no fault of their own, it is not possible.
What are the Features of the Law?
All Group and Individual Plans will be required to comply with the new regulations for plans beginning after January 1, 2022. Leading up to that, HHS will need to disclose final regulations by October 1, 1021. So, we will be getting more information in the coming months.
Some of the services discussed in the bill are already being provided by carriers. We will have to wait and see what the final regulations bring as far as additional requirements that carriers will need to add to their existing information online.
Here are the areas that the No Surprises Act touches on:
Preventing Surprise Medical Bills:
Ending Surprise Air Ambulance Bills
Audit Process and Regulations for Qualifying Payment Amounts through HHS
Determination of Rates & Dispute Resolution Process
Transparency to Members Carriers are Required to Disclose:
Deductibles and Limitations
Price Comparison Tool
Although this year has been difficult and crazy, as it ends, I’m excited to see that we may have finally put a law into place to help all Americans control Surprise Billing from Providers!