No Surprises Act: How physicians can prepare and understand its policy changes


In a press release dated January 3rd, 2022, the United States Department of Health and Human Services detailed new protections for consumers implemented by the Biden-Harris administration. Described as shielding consumers from unexpectedly large medical bills or unexpected fees, included are restrictions against unexpected bills from out-of-network providers, out-of-network facility fees, out-of-network air ambulance provider charges, and more. Generally referred to as the No Surprises Act it goes farther to restrict billing in private insurance for most emergency care and many instances of non-emergency care.

Additional stipulations require that self-pay and uninsured patients receive appropriate overviews of anticipated costs, their rights, and programs for financial assistance. This attempt to spur competition in healthcare and insurance comes amidst a decline in approval ratings and soaring medical debt among consumers. More information and the release itself can be found here:

Hailed as a bipartisan effort targeting price gauging by insurance companies, there have none-the-less been mixed responses. Doctors and hospitals scrambled to delay the January 1st implementation over the complaint that portions of the bill unfairly favor insurers1. In early December the AMA, AHA, and an undersigning of individual practices and hospitals sued the federal government to halt the rollout.

While the resultant case is still in trial, the rollout none-the-less proceeded as planned, giving practices and hospitals 30 days to resolve billing disputes or face arbitration with an independent entity assigned by the government. More information for physicians on the subtle nuances of this law can be found provided by the AMA, given in order to avoid fines and law-suits relating to failure of implementation of the new policies, it is advisable to see how the new law is going to impact your practice:

Consensus among policy makers is that the policies will operate to slow premium growth in the insurance sector, implement arbitration protocols for settling medical debts, healthcare prices will be driven to the middle (though its impact on premiums is still up for debate), and providers will be pushed to join insurance networks2.


Written by Jeremiah Ockunzzi, courtesy of Dr. Bart Rademaker, MD.







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