The “No Surprises Act,” a federal healthcare law that came into effect on January 1, 2022, aims to protect consumers from unexpected medical bills resulting from out-of-network (OON) services. Despite its noble intention to bring transparency and fairness to the billing process, it potentially opens up a plethora of questions and uncertainties for both healthcare plan members and providers.
Understanding the nuances of this law is essential for HR teams to help employees navigate the new healthcare landscape effectively. In this blog, we will delve into the intricate details of this act and the pivotal role Quantum Health is playing in aiding the seamless navigation through the provisions of this new law.
Addressing the Out-of-Network Surprises
The No Surprises Act is principally designed to limit billing by OON providers in the following scenarios:
- Emergency services — where it mandates coverage without prior authorization, irrespective of whether the facility is in-network (INN) or OON, thereby prohibiting balance billing.
- Non-emergency services at an INN facility — forbidding OON providers from balance billing for services executed at an INN contracted facility.
- Air ambulance services — putting a ban on balance billing for OON air ambulance services.
Besides establishing restrictions on balance billing, the law stipulates explicit communication of the act’s protections to consumers and offers a dispute resolution mechanism for providers dissatisfied with their payment.
One noteworthy provision is the allowance for OON providers to request consumers to waive their No Surprises protections willingly, albeit under strict regulatory conditions ensuring voluntary and informed consent.
Quantum Health: Steering Through Balance Billing Issues
Capitalizing on its rich experience garnered from assisting members and providers at state levels, Quantum Health positions itself as a pivotal contact point for elucidating the intricacies of this federal law.
Resolving Member Grievances
Quantum Health stands as a beacon of support when members receive a balance bill, assuring that no member is balance billed without explicit written consent to OON charges.
Assisting Provider Disputes
For providers contending the payment received, Quantum Health extends a helping hand by guiding them to the appropriate channels for initiating an Independent Dispute Resolution (IDR), ensuring a fair resolution without burdening the member.
As HR teams find themselves inundated with queries stemming from the act, Quantum Health emerges as a reliable partner, alleviating the workload by resolving questions and disputes promptly and effectively. By fostering a model of engagement grounded in transparency and expertise, Quantum Health ensures that the No Surprises Act serves its purpose of reducing surprise billings without escalating HR workloads.