The recently approved the No Surprises Act is a much-welcomed legislation piece that will ban Surprise Billing (aka Balance Billing) on a Federal Level. For decades, Insured Individuals would run into the circumstances of being in EMERGENCY SITUATIONS and having an Out-of-Network Ambulatory Company transport them to a hospital, or even going to an In-Network Hospital but be treated by an Out-of-Network Physician. Because these providers are Out-of-Network with the Insured’s Medical Carrier, the providers could “Balance Bill” the Insured for the difference of what is owed and what the Medical Carrier reimbursed them for. In addition, when Insureds found themselves in NON-EMERGENCY situations, where they needed a surgery or procedure and did properly use an In-Network Facility and Surgeon, but still encountered an Out-of-Network provider that they had no say in (i.e. an anesthesiologist, radiologist, nurse, etc.). The insured in this circumstance could again be “Balanced Billed” for these Out-of-Network providers, even though they didn’t have a say who they used or did not use. The No Surprises Act would mandate that in BOTH these situations all the providers be processed as “In-Network” even though they might not have a contract with the Insureds Medical Carrier. Contact us for more information how this will effect your company’s Medical Policy, 210-236-9821.
