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As an experiment, several years ago I began asking my health care providers how much my visit/procedure would cost. The responses varied from “why do you care; you are insured” to “I have absolutely no idea.” No responsible person would agree to pay for, say, an electrician without knowing the cost up front. But everyday people agree to expensive medical services without knowing the cost first. More than one patient has received a nasty surprise when they get their final bill, particularly if they went to a provider who is not in their network. This lack of price transparency has contributed to an epidemic of medical debt, which now exceeds $140 billion.

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Some of this debt can also be attributed to the practice of “balance billing,” where a health care provider will bill patients who are not in their network the difference between what they charge for the service and what the out-of-network insurance company agrees to pay. Patients who receive services from out-of-network physicians can unwittingly run up substantial “surprise” costs.   In an effort to promote transparency and eliminate surprise medical bills, in December of 2020 Congress enacted the “No Surprise Act” (NSA). After two recent rounds of rulemaking by the Centers for Medicare &amp; Medicaid Services (CMS) and the Department of Labor, totaling nearly 300 pages of regulations and commentary, this law is set to take effect on January 1, 2022. Health care providers and facilities which are not prepared to implement these new regulations by that date are in for a nasty surprise themselves, which can include civil monetary penalties of up to $10,00 for each violation. The NSA has three major provisions:

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Along with this requirement, providers must also post in a conspicuous place, and on their website, a notice advising individuals of their rights under the NSA. An example of the required notice can be found <a href="https://www.cms.gov/httpswwwcmsgovregulations-and-guidancelegislationpaperworkreductionactof1995pra-listing/cms-10780" target="_blank" rel="noreferrer noopener">here</a>.

The 300 pages of guidance, regulations and commentary published by CMS and other government agencies contain a number of other protections too lengthy to list here, including special regulations governing how much air ambulances may charge. With little time left for the unprepared, there are three important take home points:

The current rules are “interim,” which means more rules and guidance will be coming shortly. We will keep you updated.

Health Care

Of Counsel

Devin S. Schindler

The Holiday Surprise of the No Surprise Act

The Warner Norcross + Judd LLP lawyer responsible for the contents of our advertising and this website is managing partner <a href="/people/mark-j-wassink/" aria-label="Mark Wassink">Mark Wassink</a> who can be reached at <a href="mailto:mwassink@wnj.com" aria-label="email Mark Wassink">mwassink@wnj.com</a> or 616.752.2189. Please read our full <a href="/privacy-policy/" aria-label="see privacy policy">privacy policy</a> available on our website.

The Holiday Surprise of the No Surprise Act

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