No Surprise Act of 2022

The No Surprise Act of 2022 was created by the Federal Government to keep patients informed of medical costs.

Details can be found on the Centers for Medicare & Medicaid Services website: https://www.cms.gov/nosurprises

The intent is to protect patients from receiving exorbitant medical bills after treatment and services have been provided: hence - surprise medical bills.

• Part A is directed toward Hospitals and Emergency Care.

  • There have been situations where patients seek care at an In-Network facility; then receive a bill for non-covered and/or out-of-network services.
    In part, it's because hospitals contract providers, who may not be considered in-network with a patient's insurance.
    This means the patient is fully responsible for the charges, but they thought it would be covered because the services were done at their approved location.

• Part B is directed toward all providers across the board, regardless of whether the provider is a cash practice or bills insurance.

  • Self-Pay (out-of-pocket, cash); patients know and understand they are responsible for all services.

  • In-Network providers have a contract with the insurance company: they must bill the insurance directly; collect deductibles, copayments, and any services deemed non-covered.
    If there is a fee reduction, the contracted In-Network provider must accept the reduced fee as part of the contract. The patient cannot be billed for this balance.

  • Out-of-Network providers have no contract or alliance with the insurance company. The patient is responsible for all services.
    A provider can ask the patient to pay in full at the time of service, then patients seek reimbursement from the insurance on their own.
    Other providers submit claims as a courtesy and collect any potential deductibles and copayments upfront. Then wait for the insurance portion and Explanation of Benefits to determine if any unpaid balances need to be collected from the patient. This is called "balance billing" - this would fall under the "surprise medical bills" if not clearly discussed with the patient ahead of time.

• By providing estimates for care ahead of time we remove the need for payment disputes between the patient, provider, and their insurance plan.