The No Surprises Act is part of a legislative package passed in December 2020. Its primary goal is to ensure patients understand the costs of their healthcare services ahead of time, thereby reducing the likelihood of being surprised by a massive bill from their provider. While the law itself has been around for nearly a year, many of the rules implementing the law have only recently been finalized (and more are yet to come). This means that there are some actions providers need to begin taking before January 1, 2022 (the effective date for the existing rules), and providers will need to stay alert for additional changes that will be coming in the following year.

Why was the No Surprises Act passed? 

It targeted a practice known as balance billing, where a provider that is not in-network with a patient’s insurance plan would charge the patient the difference between the provider’s cash-pay rate and any payments from the patient’s insurer.  For example, if a provider normally charges $200 for a service and a patient has out-of-network coverage of 50%, the patient’s insurance company would pay $100 to the provider and then the provider would bill the patient for the remaining $100.  Insurance benefits are often hard to understand, and the patient may not have known what they would owe.  The No Surprises Act also requires notice to, and consent from, the patient to receive services from an out-of-network provider at an in-network facility.  Sometimes providers at a facility may not have a contract with a patient’s insurance plan even though the facility does.