No Surprises Act: How To Work Within the New Framework

All care professionals need to know about this new act protecting patients



October 3, 2022

Transitioning to quality care from quantity of care isn’t the only change in U.S. healthcare these days: in January of this year, the No Surprises Act dropped to protect patients from unexpected costs and overall provide a better understanding of their billing processes.

But what does this mean for providers? It’s a long story, but in short, more communication will be needed between providers and patients. Engagement tools like patient texting can help bridge these gaps and clear up any confusion!

What is the No Surprises Act?

The No Surprises Act, as of January 1, 2022, aims to help patients who have health insurance avoid surprise medical bills. This could either be an unexpected bill from a provider that was unknowingly out of network, and/or a balance bill, which is the difference between the billed cost and what the insurance covered. 

While mainly protecting those with either a group health plan and/or group or individual health insurance coverage, those with no health insurance are required to receive a “good faith” estimate of how much the care will cost before receiving it. 

Additionally, the act bans out-of-network emergency services bills without prior authorization; out-of-network coinsurance or copayments (for all emergency, some nonemergency services); and out-of-network charges and balance bills for supplemental services (for example, radiology), by out-of-network providers working at in-network facility. 

This means that patients with health insurance coverage are no longer on the hook for balance bills or out-of-network cost sharing when receiving any sort of emergency care; certain types of non-emergency care from out-of-network providers in in-network facilities; and out-of-network ambulance services.

What does this mean for providers?

These changes are big for the healthcare system in the U.S.—great for the patient, but potentially tricky for providers to manage on top of other essential responsibilities.

For one, it is up to providers to now notify patients of changes to their billing and cover their tracks so surprise billing can be avoided. An example is notice-and-consent requirements: providers must notify patients when out-of-network clinicians are providing care at an in-network facility through a disclosure that regards patient protections against balance billing. 

Providers must also now follow rules pertaining to emergency services at out-of-network or freestanding facilities, as well as good faith estimates for those without health insurance coverage.

It may seem overwhelming, but new technologies are helping providers nationwide keep in touch with patients and cover all the bases.  

Increased communication, decreased complications

With new rules come new forms of communication to make sure everyone is on the same page. Technologies like patient texting can be used to inform patients about which providers are in- and out- of-network, avoiding confusion and helping comply with the No Surprises Act. 

Texting patients can also help providers comply with this new legislature if they are struggling to reach a patient by phone or email. In fact, 97% of companies that launched texting initiatives to communicate with customers reported more efficient communication with their consumer base.

Say a patient received an emergency operation at an in-network facility, but post-operative care was to be performed by an out-of-network provider. If they’re not answering their phone or email, providers can text reminders to this patient or inform them of documents they may need to sign to acknowledge this information before receiving care.

This way, the patient can stay informed via a low-pressure communication channel, and the provider can rest assured they did all they could to comply with new healthcare laws.

Ready to utilize patient texting to stay on top of the new legislature and overall provide more comprehensive care? Learn more about patient engagement or schedule a conversation with our team today.

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