No Surprises Act (NSA)
What Is the No Surprises Act?
The No Surprises Act (NSA), under the Consolidated Appropriations Act, is a new law that officially took effect on January 1st, 2022. The purpose of the act is to protect patients from any surprise medical bills they may incur when utilizing out-of-network providers unintentionally. Unfortunately, it has become all too common for these providers to send previously undisclosed bills to patients with no warning or means of contesting them.
Peterson-KFF as well as other studies indicate that these bills occur approximately 1 out of every 5 visits to the emergency room. In fact, surprise medical bills aren’t just limited to out-of-network facilities. They can even occur when an out-of-network doctor treats a patient at an in-network hospital.
Details of the No Surprise Act
The No Surprises Act (NSA) will require providers to disclose balance billing requirements and consumer protections in a one page notice. They will be required to post this information on their website as well as make it publicly available. This disclosure notice must explain all of the following:
- All obligations and responsibilities as set out by the No Surprises Act (NSA).
- All state law requirements that explicitly outline how much any individual may be charged for services or procedures from non-participating providers.
- All contact information for any federal agencies that can assist patients should they feel they are being wrongfully charged.
The provider must provide this information by at least the date they request payment from the individual. This includes copayments requested at the time of the appointment. These can be distributed via mail, electronically or in person as well.
Does the No Surprises Act (NSA) Always Apply?
The No Surprises Act (NSA) has banned the most common forms of balance billing, which refers to the difference between what is owed and what the insurance provider has paid out. There are exceptions to this rule, primarily when not involving emergency care services. For example, if a patient is provided with the correct billing information with advanced notice, and they consent to pay for any out-of-pocket payments owed, then the No Surprises Act (NSA) would not apply. Should a patient refuse to consent, however, the No Surprises Act (NSA) protections would remain intact.
Related Terms: Health Insurance