No Surprises Act

In January 2022, the “No Surprises Act” was a piece of legislation passed in the United States as part of the Consolidated Appropriations Act, 2021. In short, it means before we start working together you will know how much you are expected to pay including co-payments and your insurance benefits.

The No Surprises Act primarily addresses surprise medical billing, which occurs when patients receive unexpected bills for out-of-network healthcare services, often in emergencies or when they thought they were using in-network providers. The key provisions of the No Surprises Act include:

  1. Out-of-Network Billing Protections: The Act protects patients from receiving surprise medical bills for emergency services, as well as certain non-emergency services performed by out-of-network providers at in-network facilities.
  2. Independent Dispute Resolution (IDR): Disputes between healthcare providers and insurers regarding the cost of out-of-network services are resolved through an independent dispute resolution process. This process aims to ensure a fair resolution without burdening patients with excessive costs.
  3. Transparency Requirements: The legislation includes provisions to enhance transparency in healthcare pricing. Insurers are required to provide clear and understandable information about cost-sharing and coverage details, enabling patients to make more informed decisions about their healthcare.
  4. Advance Explanation of Benefits (EOB): Patients will receive an advance Explanation of Benefits to help them understand the expected costs of medical services before receiving care.