What the No Surprises Act means for healthcare payers

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The No Surprises Act was signed into law in December 2020. Here’s what healthcare payers should know to prepare before the law goes into effect on January 1, 2022.

📄✍🚨With the passage of the No Surprises Act, the regulatory pressures on healthcare payers and providers continue to increase. Read our guide on the 6 actions payers can take to prepare.

What you can do now to prepare before the No Surprises Act goes into effect in early 2022


What’s the “surprise” in the No Surprises Act?

​The No Surprises Act, a $1.4 trillion year-end spending bill centers on so-called “surprise medical billing,” which is actually more commonly known as out-of-network billing. Out-of-network billing happens when a patient receives a bill for the difference between ​​​​the out-of-network provider’s fee and the amount covered by the patient’s health insurance after copays and deductibles.​​​

How often does that actually happen? According to a KFF poll, 1 in 3 insured adults between the ages of 18 and 64 received an unexpected medical bill in the last two years. Of those, 16 percent reported they received a “surprise” bill related to care received from an out-of-network provider.

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Further, 65 percent of insured adults between 18 and 64 indicated they are either “very worried” (35 percent) or “somewhat worried” (30 percent) about being able to afford unexpected medical bills. That concern topped the list of things this age group worries about.

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What the No Surprises Act covers

The No Surprises Act seeks to lessen this worry for insured Americans by increasing transparency regarding medical billing and patient cost-sharing responsibility. Here are the main requirements of the law: 

Are there exceptions to the new regulations?

​There are some exceptions to the new regulations. If a patient knowingly and willingly consents to use an out-of-network provider for non-emergency services, the surprise billing protections do not apply.

KFF notes regarding this exception: “An exception applies for certain non-emergency services if providers give prior written notice at least 72 hours in advance and obtain the patient’s written consent. The notice must indicate the provider does not participate in-network, provide a good faith estimate of out-of-network charges, and include a list of other participating providers in the facility whom the patient could select. This exception does not apply for ancillary services (such as anesthesia) or diagnostic services (such as radiology and lab) nor to other services or providers” specified in the regulation.

What the No Surprises Act means for payers

​The No Surprises Act requires several things from payer organizations.

What should payer organizations do to prepare now?

2022 is fast approaching, so payer organizations must take action now to prepare. Here are some steps to take:

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Let RingCentral help you implement a member engagement communication plan

​As regulatory pressures continue to increase, member engagement ​​​will become even more important than ever before. Educating and engaging your members will help you mitigate risks, retain members, and keep costs lower for all your members. 

RingCentral provides a healthcare communications platform that enables strong member engagement across multiple channels—channels that your members prefer. To learn more about what RingCentral can do for your payer organization, get in touch and request a demo today.

Originally published Nov 16, 2021, updated Nov 09, 2021

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