No Surprises Billing Act

What does the No Surprises Billing Act mean?

The No Surprises Act (NSA) establishes new federal protections against surprise medical bills effective January 1st, 2022.  Surprise medical bills arise when insured consumers inadvertently receive care from out-of-network hospitals, physicians, or other providers they did not choose.  Surprise medical bills pose financial burdens on consumers when health plans deny out-of-network claims or apply higher out-of-network cost sharing; consumers also face “balance billing” from out-of-network providers that have not contracted to accept discounted payment rates from their health plan.

The No Surprises Billing Act will protect consumers from surprise medical bills by:                                                                                                                                                                                                           

  • Requiring private health plans to cover out-of-network claims and apply in-network cost sharing. 
  • Prohibiting physicians, hospitals and other covered providers from billing patients more than in-network cost sharing amount for surprise medical bills.
  • The No Surprises Billing Act also establishes a process for determining the payment amount for surprise, out-of-network medical bills, starting with negotiations between plans and providers and, if negotiations don’t succeed, an independent dispute resolution process. 

More information regarding Your Rights and Protections Against Surprise Medical Bills, CLICK HERE.

 

Good-faith estimates

Beginning January 1, 2022, Anderson Healthcare facilities and providers will provide a good-faith estimate of expected charges to uninsured consumers, or to insured consumers if they don’t plan to have their health plan help cover the costs (self-paying individuals). The good-faith estimate will be provided after a patient has scheduled an item or service, or upon their request. It should include expected charges for the primary item or service they, and any other items or services that are provided as part of the same scheduled experience.

Community Hospital of Staunton will:

  • Provide the good-faith estimate within certain timeframes.
  • Offer an itemized list of each item or service, grouped by the provider or facility offering care.
  • Explain the good-faith estimate to the patient over the phone or in-person if the patient requests it, and then follow up with a paper or electronic estimate.
  • Provide the good-faith estimate in a way that’s accessible to our patients.

More information regarding your right to receive a Good Faith Estimate, CLICK HERE