No Surprises Act Summary and What Employers and Employees Need to Know

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As of January 2022, the “No Surprise Act” provides protection for consumers from unexpected bills for out-of-network care in an emergency and certain non-emergency settings. By enforcing better consumer protection and price transparency, the new regulations will help create better patient experiences and provide better financial protection for individuals.

Here are a few of the protections you should be aware of:

  1. The No Surprise Act protects patients from receiving surprise medical bills or balance billing resulting from emergency services from out-of-network providers or out-of-network air ambulance services without prior authorization. In other words, you should not be charged more than in-network cost-sharing for specific out-of-network services.
  2. The Act bans out-of-network charges for certain services if the individual is at an in-network facility, including services such as anesthesiology or radiology provided by out-of-network providers. The reason for this is because individuals would not know that the provider is out-of-network if they are at an in-network facility.
  3. The Act requires health care providers and facilities to provide individuals with an easy-to-understand notice explaining the applicable billing provisions and who to contact if the provider or facility has violated the individual’s new protections.
  4. The Act also includes requirements that facilities provide “Good Faith Estimates” to individuals and Advance Explanation of Benefits. More guidance on this provision are still being formalized as of 2022.

We believe that The No Surprise Act creates better financial protection for consumers.

For more information on how MNJ Insurance Solutions can help your company and employees, please contact us today.