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No Surprises Act: perspectives on the status of the consumer protections against balance billing
No Surprises Act: perspectives on the status of the consumer protections against balance billing
- Collection:
- Health Policy and Services Research
- Author(s):
- Hoadley, Jack, author
Lucia, Kevin, author
Volk, JoAnn, author
Walsh-Alker, Emma, author
Swindle, Rachel, author
Wengle, Erik, author - Contributor(s):
- Robert Wood Johnson Foundation, issuing body.
Urban Institute, issuing body. - Publication:
- Washington, DC : Urban Institute, April 2023
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Consumer Advocacy -- legislation & jurisprudence
Health Equity -- economics
Health Expenditures -- legislation & jurisprudence
Health Policy
United States - Genre(s):
- Technical Report
- Abstract:
- The No Surprises Act (NSA), enacted in December 2020, created new protections for 177 million Americans with private health insurance. Specifically, the NSA protects consumers from many of the most prevalent forms of surprise balance billing by out-of-network providers and facilities in the emergency, air ambulance, and in-network hospital settings. Before passage of the law, consumers were most vulnerable to balance billing when they used an out-of-network provider in situations when they could not reasonably choose how they obtained medical services. The reality is that not all medical services are delivered in network. For example, 18 percent of emergency visits and 16 percent of in-network hospital care resulted in at least one out-of-network charge for enrollees of large group plans in 2017. Air ambulance services were even more likely to be out of network. Balance bills to consumers could potentially be large, in the range of $20,000 for air ambulances, $3,600 for surgical assistants, and $1,200 for anesthesiologists. Even though many people did not experience balance bills, they were a source of concern. According to a 2020 poll, 65 percent of insured adults were at least “somewhat worried” about unexpected medical bills. States were the first to rise to the challenge to protect consumers from surprise balance bills. By 2020, 33 states had at least some protections in place, and 18 of those states had comprehensive protections. But even for consumers in these states, federal restrictions allowed significant gaps to remain. States were generally unable to provide protections for individuals with self-funded plans sponsored by employers and unions, for those receiving air ambulance services, and for services in which multiple states are involved. The NSA now fills all of these gaps. This brief considers how well NSA protections are working after being in effect for one full year. Based on structured interviews with federal and state regulators and a broad spectrum of stakeholders, the NSA appears to be protecting patients from the most pervasive forms of balance billing and getting consumers “out of the middle” of payment disputes between providers and payors (i.e., health plans and insurers). Physicians, hospitals, and payors have taken critical steps to adjust operational processes to mitigate the risk of consumers receiving balance bills for services covered by the NSA and to pay only in-network cost sharing for those services. It is too early to assess whether the NSA will constrain the growth in health insurance premiums and encourage broader provider networks, and there remain concerns that coverage gaps in the NSA, such as for ground ambulance services, can leave consumers with unexpected financial liability.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-DC license. (More information)
- Extent:
- 1 online resource (1 PDF file (16 pages))
- NLM Unique ID:
- 9918627784306676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918627784306676