By this point, we’re all aware that the No Surprises Act goes into effect on January 1, 2022. But you may not be fully aware of what the No Surprises Act means for your employees. It’s time to take a look at this Act from a different lens –– the perspective of your employees –– in order to fully understand what it means for them and how you can effectively communicate its ins and outs.
In simple terms: the rule bans providers from issuing surprise billing to patients for out-of-network coverage. This protects patients, like your employees, from financial hardship due to surprise medical costs. While the general message of “no surprise billing” is most likely understood across your employees, it’s important to break it down a bit and get into the nitty-gritty details clearly and concisely. As an employer, employees may rely upon you to communicate any information regarding their medical coverage, making it critical for you to execute palatable communications to anticipate and answer their questions.
First, ensure your employees understand how the No Surprises Act affects billing for emergency services. The regulation bans any surprise billing for emergency services, whether that be in a hospital (like a traditional Emergency Room) or a free-standing emergency department (think Urgent Care facilities that also provide emergency services). When receiving emergency care, your employees must be treated on an in-network basis without requirements for prior authorization. So, three weeks after their treatment, your employees will not receive an outrageous bill in the mail for out-of-network emergency services.
Another area in healthcare that encounters surprise billing is ancillary care by out-of-network providers. While your employees may be in non-emergency situations at an in-network facility, if they receive care from an ancillary provider, they would be charged the out-of-network cost. For example, if your employee is undergoing a planned knee replacement surgery at an in-network hospital by an in-network surgeon, but the anesthesiologist that treated them was an ancillary provider — they’d typically see a bill on an out-of-network basis for the anesthesia services. This bill would be in addition to the out-of-pocket amount your employee would be responsible for. However, under the No Surprises Act, this is no longer the case. Your employees are only responsible for paying the in-network cost-share for out-of-network services.
While the No Surprises Act’s core theme is to protect your employees from surprise out-of-network billing, it does not restrict your employees from voluntarily choosing care from an out-of-network provider. However, if employees decide to go with their preferred out-of-network provider, the provider or facility is required to give them a plain-language consumer notice explaining that they must acknowledge and consent to the service being provided at an out-of-network rate — making them responsible for any billed amount.
In an effort to combat situations where your employees may receive care from out-of-network providers, health plans are now required to update their provider directory at least every 90 days. They must also respond within one business day to requests regarding whether or not a provider or facility is in-network. And, if your employees rely on incorrect information published by plans or in directories, they are entitled to have those services covered with in-network cost-sharing applied. (Bottom line: Make sure your employees have clear access to your health plan’s provider directory.)
The No Surprises Act is a tremendous step in protecting your employees from surprise billing when receiving the medical care they deserve. If you’re looking for a more in-depth look at the No Surprises Act and a summary of healthcare provisions it includes, take the time to read this.
And, if you’re looking for an innovative and informed partner to help you and your employees understand current legislation and healthcare trends that can save them headaches and money — connect with our team at Totem today.