The Unsurprising Law and Price Transparency in Health Care: How Upcoming Health Care Reforms Will Benefit Consumers
NEW YORK – December 10, 2021 – (Newswire.com)
Credello: Many patients receiving health services in the United States have no idea what it costs. And that lack of transparency can lead to surprise bills that show up at your doorstep weeks or months after receiving care. The good news is that the No Surprises Act, which comes into effect on January 1, 2022, is designed to protect consumers from these types of surprise bills. Here’s what you need to know about the No Surprises Act, the Transparency Coverage Rule, and how upcoming healthcare reforms will benefit consumers.
What is the law without surprises?
The No Surprises Act, part of the largest consolidated credit law of 2021, is designed to protect consumers from surprise bills. Many of these bills are the result of emergency situations where consumers are forced to use off-grid care. Providers are prohibited by law from charging their patients more than they would for cost sharing in the network, except for overland ambulance transport.
This type of surprise billing can occur when a patient receives emergency care at a network facility from an off-network provider. And in an emergency situation, generally, the patient is not able to seek care from the providers of the network, nor cannot be accessible according to the circumstances.
How does the No Surprises law protect consumers?
The law provides several protections for consumers, including:
- Healthcare providers should cover emergency services rendered by an off-grid provider without prior authorization.
- The cost-sharing requirement for any off-grid service cannot be greater than those that would apply to a participating provider.
- All consumption payments applied for these emergency services will count towards the network deductible and the participant’s maximum expenditure.
The benefits of the law without surprises for consumers
The main benefit of this law for consumers is that they will no longer run the risk of massive off-grid surprise bills if they received emergency care or were transported by an air ambulance. And that means consumers who may already be facing significant medical debt now have the ability to control their debt without accumulating additional charges.
If you are looking to deal with medical debt, a popular way to quickly pay off what is owed to you is to medical debt consolidation. If you have a high credit score that may qualify you for a lower interest rate loan, debt consolidation for medical bills might be an option to consider.
What is the coverage transparency rule?
The rule of transparency of coverage aims to give consumers better access to their medical information. As of January 1, 2022, the rule requires health plans and insurers to grant online access to information such as:
- Rates negotiated for the services covered between the health plan and the network providers.
- Network-negotiated rates and prices for prescription drugs covered at a particular pharmacy.
- Payment and fee history for off-grid providers.
How the No Surprises Law and the Cover Transparency Rule Increase Transparency
There are several key ways in which the No Surprises Law and the Transparency of Coverage Rule help to increase transparency in healthcare:
- Providers and insurers must provide consumers with good faith cost estimates before medical services are rendered.
- Information in the supplier directory must be kept up to date by insurers and suppliers.
- Insurers must disclose deductibles inside and outside the network and maximum amounts payable.
The government expects this legislation to help consumers better evaluate health care options, negotiate better rates and lower the cost of medical care.
Press Releases Department