The No Surprises Act is effective from January 2022

The No Surprises Act went into effect in January 2022 as part of the Consolidated Appropriations Act of 2021. The purpose of the law is to address surprise or offset billings imposed by health plans when using out-of-network providers. Insurance companies are prohibited from charging higher rates or denying claims for care obtained from out-of-network providers of emergency services and, in some cases, certain services provided by out-of-network physicians at in-network facilities. It states that the health fund should cover these services as if they were within the network.

The law also requires insurers to send beneficiaries an AEOB for upcoming actions or services as a “good faith estimate” of the costs they will incur. The information provided in this AEOB shall cover whether each provider or facility is in-network or off-network, the contracted rate of service, how in-network-only providers are obtained, all expected fees, any cost-sharing amounts and whether prior authorization applies (or other terms).

Many plans may try to get around these requirements by having you sign a surprise billing protection form. Think carefully before signing this form as it may limit your consumer protection rights. It basically says that you are willing to pay out-of-network rates for any services run by out-of-network providers. The form must be provided to you at least 72 hours prior to receiving care, and an estimate of good faith must be included on the form. Providers that are prohibited from giving you this form include emergency room physicians, anesthesiologists, assistant surgeons, and radiologists.

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