September 2021

No More Surprises—New Regulations Will Help Members and Protect Plan Sponsors

9/29/2021 12:16:01 PM

No More Surprises—New Regulations Will Help Members and Protect Plan Sponsors

By Ron Wozny, Senior Vice President of Marketing

There’s a good chance that you have either received a surprise bill for medical care, or that you know someone who has.  Surprise medical bills are not uncommon. Among privately insured patients, an estimated one in five emergency claims and one in six in-network hospitalizations include at least one out-of-network (surprise) bill. And tackling surprise billing is important as it often has devastating financial consequences for individuals & their families. Two-thirds of all bankruptcies filed in the United States are tied to medical expenses.

Surprise bills often arise in emergencies, when patients typically have little or no say in where they receive care. They also arise in non-emergencies when patients at in-network hospitals or other facilities receive care from ancillary providers such as anesthesiologists or radiologists who are not in-network and whom the patient did not choose. As these bills became more common—and more expensive—payers, providers and regulators have been negotiating to find solutions that consistent and fair for everyone involved, without much luck.

In late 2020, Congress included a provision in the COVID relief bill banning surprise bills. The regulations start to take effect on January 1, 2022, and they make certain requirements of health plans. For self-insured employers, responsibility for compliance lies with the plan, not the benefits administrator; we believe that benefits administrators are responsible for taking action to be sure that their clients are compliant with all requirements of the law.  

HealthSmart is committed to working with our clients and their broker partners in maintaining compliance with all applicable laws, including the Price Transparency Act and the No Surprises Act. As part of that effort, we have just released a new e-book outlining key provisions in the No Surprises Act, and the actions we’re taking to help.

Download the No Surprises Act E-book 

Download the Transparency White Paper

Watch the Transparency Act Webinar Recorded 9/15/21