The No Surprises Act takes effect Jan 1 2022. To summarize, VERY briefly, it will mean ;
Health plans must cover surprise bills at in-network rates; even bills from out-of-network providers Balance billing is prohibited Out-of-network providers cannot send patients bills for excess charges
One of the issues that’s been resolved in the bill is the agreed payment amount for the out-of-network providers. If they don’t agree on a payment amount, the insurer and the provider must use an independent dispute resolution (IDR) process to decide the amount. THIS is where the Act protects patients; in the past, the provider was free to bill the patient, and the insurer had no responsibility or even authority to direct the process, so the patient was on the hook for the bill. The IDR process takes the patient out of the process, and the insurer and provider have to work it out.
However, the federal rules governing the IDR process, and a complaints process for patients, may not be complete until July 2022. Which brings me to my question;
if I get a surprise bill before July 2022, will it still be illegal? One would presume so.
If I did get a bill, with no complaints or IDR process, will anything have really changed for patients?
I have to have a procedure next year, and I’m wondering how far into 2022 I should wait.
submitted by /u/00derek
[link] [comments]The No Surprises Act takes effect Jan 1 2022. To summarize, VERY briefly, it will mean ; Health plans must cover surprise bills at in-network rates; even bills from out-of-network providers Balance billing is prohibited Out-of-network providers cannot send patients bills for excess charges source; https://www.kff.org/private-insurance/fact-sheet/surprise-medical-bills-new-protections-for-consumers-take-effect-in-2022/ One of the issues that’s been resolved in the bill is the agreed payment amount for the out-of-network providers. If they don’t agree on a payment amount, the insurer and the provider must use an independent dispute resolution (IDR) process to decide the amount. THIS is where the Act protects patients; in the past, the provider was free to bill the patient, and the insurer had no responsibility or even authority to direct the process, so the patient was on the hook for the bill. The IDR process takes the patient out of the process, and the insurer and provider have to work it out. However, the federal rules governing the IDR process, and a complaints process for patients, may not be complete until July 2022. Which brings me to my question; if I get a surprise bill before July 2022, will it still be illegal? One would presume so. If I did get a bill, with no complaints or IDR process, will anything have really changed for patients? I have to have a procedure next year, and I’m wondering how far into 2022 I should wait. submitted by /u/00derek [link] [comments]Read Morer/HealthInsurance