Surprise Billing

About Surprise Billing

The No Surprises Act protects people covered under group and individual health plans from receiving surprise medical bills for most emergency services, non-emergency services from out-of-network providers at in-network facilities, and services from out-of-network air ambulance service providers. While California hospitals are already leaders in ensuring patients understand their out-of-pocket costs and offering clear, written discount and charity care policies to help certain patients, new AHA guidelines are a way for hospitals to reinforce their commitment.

No Surprises Act: Dispute Resolution Process and Self-Pay Estimates

On September 30th, The Departments of Health and Human Services (HHS), Labor, and Treasury released an interim final rule (IFR) providing additional regulations implementing the No Surprises Act. The rule includes: Provisions related to the independent dispute resolution (IDR) process Good faith estimate for uninsured individuals The patient-provider dispute resolution process The rule also requires IDR entities […]

Interim Surprise Billing Rule Hurts Patients

As California’s hospitals continue to slog through the peaks and valleys of the COVID-19 pandemic, all while enduring incessant and devastating blows to the resources they rely on for patient care, an additional burden from the federal government is beginning to materialize. 

CHA Comments on No Surprises Act Enforcement Provisions Proposed Rule

CHA commented on the proposed rule detailing the enforcement provisions related to the No Surprises Act (NSA). In the letter, CHA raises concerns about the promulgation of regulations related to enforcement actions before the full set of regulations required to implement the NSA’s core provisions have been produced.   CHA also offers specific technical recommendations to ensure that providers have an appropriate opportunity to respond […]

CHA Comments on No Surprises Act Regulation

CHA submitted comments on the interim final rule with comment period implementing the No Surprises Act.  In the letter, while CHA supports efforts to reduce patients’ out-of-pocket costs for health care, CHA raises a number of concerns with provisions of the interim final rule, including the qualified payment amount calculation and notice and consent process.   Additionally, CHA asks the tri-agencies to protect patients from confusion and consumers from higher premiums — resulting from […]

No Surprises Act: Implementation for California Hospitals

On July 1, the Departments of Health and Human Services, Labor, and Treasury (tri-agencies) released an interim final rule implementing the No Surprises Act.   Beginning on Jan. 1, 2022, the Act, among other things, prohibits balance billing by limiting cost sharing to the in-network amount for:   Emergency services provided by out-of-network facilities and providers  Certain situations where a patient receives care from an out-of-network provider at an in-network facility    […]

CHA Submits Pre-Regulatory Comments on No Surprises Act

CHA has submitted comments to the Departments of Health and Human Services, Labor, and Treasury related to the implementation of the No Surprises Act.  

The legislation limits patient out-of-pocket costs to the in-network amount for emergency medical care provided by out-of-network facilities and providers and in certain situations where care is delivered at an in-network facility by an out-of-network provider.