The No Surprises Act, which took effect on Jan. 1, 2022, means healthcare providers and insurance companies can no longer charge you for out-of-network care for most emergency services and non-emergency services (e.g., radiology, anesthesiology, pathology, etc.) provided at in-network facilities.
A lot of employers are wondering what the No Surprises Act means for them. Although it is an insured employee’s responsibility to dispute any surprise charges, employers can—and should—help employees understand the new law and the resources available to them.
There are 3 immediate things employers can do:
Communicate how the No Surprises Act works with the company health plan.
Make sure employees understand the act, its exclusions as well as the new process between the health plan and out-of-network providers for qualifying claims. Be sure to explain that when they schedule medical services, they must receive advance notice of and consent to being billed out-of-network charges.
Explain how employees can appeal health plan denials.
It’s up to employees to recognize when surprise billing protections should apply—and seek help. The first line of defense is appeal to the health plan/insurance carrier. Then if the health plan upholds its decision, employees can appeal to an independent external reviewer. If that route is necessary, employees can use the resources below to guide them:
- No Surprises Help Desk: 800-985-3059
- FAQs
Remind employees to choose in-network care first whenever possible.
In-network care will always be the most affordable option and should be part of the ongoing education you conduct throughout the year to help employees understand how healthcare insurance and billing works.
If you’re interested in making your benefits communication more relatable and useful to your employees, contact us today. We’d love to help you.
