In December 2020, Congress signed the Consolidated Appropriations Act (CAA) into law. One section of the new law, referred to as the No Surprises Act, requires carriers to display deductible and maximum out-of-pocket limitations on member ID cards for coverage beginning January 1, 2022. The No Surprises Act is designed to prevent consumers from facing unexpected out-of-network expenses. While there are many provisions built into this law, one of them includes the new requirement for insurance carriers to make cost-sharing details readily available to patients, and in turn, to the healthcare providers that serve them. Whether the ID card is in physical or electronic format, it must also include a telephone number and website where the patient can go to determine if the healthcare provider is in-network with that insurance plan. The additional details should empower patients, healthcare providers, and medical billing services, to make better informed decisions about expected costs of care.
The No Surprises Act applies to patients that have health insurance through an employer, the Health Insurance Marketplace, or individual plans purchased directly from an insurance company. Additional provisions include:
- Ban of surprise bills for out-of-network emergency services.
- Ban of out-of-network charges and balance bills for providers that are OUT-of-network with an insurance plan with which the Facility (ex: hospital) is IN-network. An example of this may include receiving an out-of-network bill from an anesthesiologist that assisted with an in-network surgery at a hospital.
- Requirement for providers that are out-of-network to provide an easy-to-understand notice to patients that advises that out-of-network care may be more expensive and the patient has options to avoid balance bills.
Additional information for both patients, healthcare providers, and medical billing services can be found at the Centers for Medicare & Medicaid Services (CMS) website.