The No Surprises Act in Healthcare
Sindhu Kutty shares an article that explores the No Surprises Act introduced in January of this year and offers a few suggestions that could improve it.
As a business owner, and one with more than 20 years of experience in the healthcare space, I know that maneuvering through the outrageous complexity of the provider and payor space to offer healthcare to our employees was beyond taxing. So, I can’t imagine what it must be like for the average consumer. Why is it that I can get a quote for just about any service these days through an app on my phone within minutes, but asking for transparency in what I might be charged as a patient is an insurmountable task?
Case in point, if someone undergoes surgery at a hospital, the total cost is known only months after the date of care and flits into their mailbox through multiple invoices from different departments at the same hospital. This also might include “surprise” out-of-network bills, which can be exorbitant. So why do patients have to pay outrageous rates for out-of-network providers when they often lack the opportunity to choose? For surgical procedures, people can typically pick their hospital facility and primary surgeon, but they can’t select any other member of the surgical team (for example, anesthesiologist, radiologist). The same goes for emergencies when someone is transported to a hospital outside of their network or an in-network hospital that is staffed with out-of-network clinicians.
So, what are some of the protections that the act will bring patients? The primary protection is the notice and consent process. An out-of-network provider must notify a patient of their status and obtain written consent to receive out-of-network services more than 72 hours before it’s provided. This brings the decision-making ability back to the patient. In scenarios where patients are unable to select, the act defines a “no exception group,” and insurers must treat all of these clinician’s services as in-network for patient cost-sharing, deductibles and out-of-pocket limits. Note that several states have existing laws that regulate surprise billing, but many don’t prohibit surprise billing for emergency services; the federal law will cover these services as well and will supersede state laws.
Key points include:
- The notice and consent process
- How to make the transition easier for consumers
- Increasing transparency
Read the full article, The No Surprises Act, on KuroshioConsulting.com.