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No Surprises Act Delivers On Promises

February 20th, 2024 – The No Surprises Act was designed to shield consumers who have their insurance through work or individually from unexpected out of network claims for sudden illness and injury. Most often this involves being billed for emergency services received from a provider who is out of network.

However, it can also include balance billing for non-emergency out of network supplemental services received at an in-network facility. You may be asked to sign a waiver that waives your rights to non-emergency protections (post-stabilization services) by the facility. You are NOT required to agree to this, so it pays to pay attention to what you are signing.

Is the new consumer protection law working? It seems so as a new survey reports that patients were protected by 10 million bills thus far, thanks to the No Surprises Act. The surveyed payers represented 139 million covered lives in the commercial (employer) market.

80% of the claims subject to the No Surprises Act were resolved by the insurance carrier with no further assistance needed. The other 20% required intervention through the Independent Dispute Resolution process, which far exceeded preliminary estimates. The hope is that providers will join more insurers’ networks to avoid the laborious Independent Dispute Resolution process.

If unable to resolve a claim with the provider, consumers can file a complaint online at the CMS.gov website.

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