Effective for health plan years beginning on or after January 1, 2022, the No Surprises Act (NSA) is federal legislation that established new protections for insured consumers who inadvertently receive care from out-of-network hospitals, doctors, or other providers. Key provisions in the NSA cover both emergencies and non-emergencies and establishes an independent dispute resolution 30-day period for the plan and provider to try to negotiate a payment amount for any surprise medical bill. But what does this all mean in practice?
Watch this installment of Madaket Minute for an overview of the NSA and what happened in one case when a physician tried to challenge it.
Read the “No Surprises Act and why you will lose when you challenge” video transcript below and subscribe to Madaket Health on YouTube.
Hi, I’m Devon with Madaket Health! Welcome to this installment of the Madaket Minute, where we’re looking for feedback and thoughts on today’s topic: the No Surprises Act.
If you don’t know anything about the No Surprises Act, it’s a federal law that was enacted January 1st of this year giving consumers new billing protections as they seek emergency care, non-emergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers. It also gives consumers protections against excessive out-of-pocket costs and, though a consumer might not have a prior authorization for a procedure, emergency services must still be covered regardless of whether that provider or facility is in network.
Now, according to an article released this summer by Reuters, a New York surgeon attempted to challenge the No Surprises Act, arguing that the law is unconstitutional because it allows payers to define the standards of the Independent Dispute Resolution (IDR), which basically dictates what the physician’s out-of-network rates would be and prevents the physician from being able to balance bill their patients and hold trial if needed to collect on these out-of-network costs. In the end, he lost the challenge and the lawsuit was dismissed
What do you think? Is it unconstitutional? Leave your comments below and we’ll be back next week for another Madaket Minute.