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The No Surprises Act is a new bill that came into effect in the beginning of 2022. It was enacted to protect patients who inadvertently receive care from an out-of-network provider that they did not choose on their own and as a result, these medical bills pose a financial hardship to these patients.

What do you need to know about the No Surprises Act? 

The services that are covered under this bill are as follows:

1)   Emergency services, including hospital-based and urgent care centers,

2)   Post-emergency stabilization services, which may be hospital-based after receiving emergency services and this care will continue until the provider, or a provider in the hospital or at the facility determines that the patient can travel safely to another facility without medical transport, with patient consent. 

3)  Non-emergency services at in-network facilities. This includes out-of-network providers at in-network facilities or hospitals. The type of services that fall underneath this category include but may not be limited to, the following: treatment to the patient directly, equipment and devices, telemedicine, imaging and lab, and the pre and post-operative services. 

The overall concept is that this new bill will prevent healthcare practitioners from billing patients more than the in-network costs for the services, under the parameters indicated above. Should a provider violate this bill, there may be a fine of up to $10,000 per violation. 

What is required by the provider underneath the No Surprises Act? 

Providers will now need to provide an out-of-network invoice to the patient’s health plan if the services or any of the previously stated conditions are evident. The insurance carriers then have up to 30 days to respond regarding what the in-network cost will be so that the provider can then direct the patient accordingly, along with a written notice provided to the patient directly from their insurance carrier. 

For all medical practices, a patient consent waiver will now be required regarding this bill and its potential effects.  

What is included in the consent waiver form?

The waiver should include the following information pursuant to the bill:

1) a statement that patients are not required to waive, and can find an in-network provider 

2) a statement that an out-of-network provider can refuse to treat should the patient refuse to sign the waiver consent form. 

3) a statement that waiving protections can cost the patient more money, as they will be paying an out-of-network provider, and their health plan may not cover; and 

4) a description of the services being provided, and at the provider’s option, including the approximate value or cost of the treatment that will be received as a result. 

This waiver consent form must be provided at least 72 hours before treatment is rendered, but no later than the day of treatment. 

You can refer to the following link for further information or discuss this with your local counsel. https://www.cms.gov/nosurprises.