CHA has provided resources to help members navigate the implementation of the No Surprises Act requirements. The resources include the latest implementation updates, summaries of legislation and related rules, CHA advocacy efforts, and on-demand webinars that discuss each of the provisions to be implemented.
The No Surprises Act prohibits balance billing for emergency services and in instances where health care services are received from an out-of-network provider at an in-network facility for federally regulated health insurance products. In instances covered by the act, patient cost sharing is limited to the in-network amount.
If a provider or facility is not satisfied with the initial payment from a health plan for out-of-network services covered by the act, the provider or facility may attempt to negotiate a satisfactory payment with the plan. In instances where an appropriate amount cannot be negotiated, the provider or facility may submit the claim to an independent dispute resolution process to determine the appropriate payment amount.
The law also requires providers and facilities to give patients a good faith estimate of expected charges for scheduled services or upon request. Many of the provisions of the No Surprises Act are effective Jan. 1, 2022.