Texas Tech University Health Sciences Center
The New Year and the No Surprises Act

The New Year and the No Surprises Act

Welcome to 2022!  As we deal with the surge in Covid-19 due to the highly contagious Omicron variant of the virus raging through our nation (and I hope you and yours are well, BTW)—we are also dealing with the No Surprises Act (NSA). This new federal law went into effect on January 1. Have you heard about it? Basically, the NSA establishes new protections against surprise medical bills. The NSA also requires providers to give an uninsured (self-pay) individual a good faith estimate of expected charges. This estimate has to include expected charges for the primary item or service, as well as for any other items or service that would reasonably be expected to be provided as part of the same scheduled or requested item/service.

What are surprise medical bills? These are bills that come up when insured consumers receive care from out-of-network hospitals, doctors, or other providers they did not choose. As you can guess, a high percentage of this occurs in connection with emergency department visits, about twenty percent of the time. However, it will affect Texas Tech Physicians because, according to a Kaiser newsletter, between 9% and 16% of in-network hospitalizations for non-emergency care include these surprise bills from out-of-network providers, such as anesthesiologists and pathologists, whom the patient did not choose.

It is true that surprise medical bills can create financial problems for consumers when health plans deny out-of-network claims or apply higher out-of-network cost sharing. We get that, and there are many horror stories about people being hit with huge medical bills when they go to certain providers (I am not talking about us so much). But it can hurt providers, too, when bills become uncollectible.

Consumers face “balance billing” from out-of-network providers that have not contracted to accept discounted payment rates for a health plan—but, again, that does not mean Texas Tech Physicians will necessarily collect on “balance billing.” Much of this has to be written off as uncollectible. The federal government estimates the NSA will apply to about 10 million out-of-network surprise medical bills a year. That is a huge number. The law applies to anyone with any type of health insurance except Medicare.  

In summary, the law bans balance bills: (1) in emergencies, (2) repeating myself here—when the patient did not have a choice of doctors for medical services, or (3) for air ambulance services. The last one obviously does not apply to us. Brett Swett, Managing Director of the MPIP Business Office, and a number of us have been preparing for the changes. I asked Brett, for the purposes of this article, what he thought the greatest impact of NSA would be on Texas Tech Physicians.

“I believe the biggest challenge out of the gate will be complying with the good faith estimates for self-pay individuals. The most difficult part of this requirement will be including all items or services that would reasonably be expected to be provided as part of the same scheduled or requested items/services, as this includes services such as labs and imaging that might be provided by another entity. Working to comply with the good faith estimate requirement will take a lot of coordination among our departments, as well as other entities that help us provide care to our patients,” said Brett.        

So, we will have to see how all of this plays out. I think the intent is good, but it is always those nasty unintended consequences that we have to anticipate.
Have a great week!