No Surprises Act - are you ready?

The Consolidated Appropriations Act (CAA) is arguably the most significant reform affecting health care costs since the passage of the Affordable Care Act (ACA). One of its most notable components is the No Surprises Act.

Starting January 1, 2022, the new law effectively protects consumers from surprise medical bills, unless prior consent has been given. This includes the elimination of balance billing when

• receiving out-of-network emergency care,
• receiving certain ancillary services provided by out-of-network providers in an in-network facility, and
• transported by an air ambulance.

Group health plans have an obligation to educate consumers about their new rights, and the Department of Labor has provided a model notice to include on each explanation of benefits for a medical service subject to the new law.

The No Surprises Act establishes an Independent Dispute Resolution (IDR) process to resolve payment disputes between health plans and providers. Consumers are removed from the process, eliminating the hassle and financial burden that has long been associated with balance billing. View our IDR process flow chart to learn more.