The No Surprises Act and Its Significant Implementation Challenges

• November 10, 2023

• Josh Arters , Polsinelli PC

The No Surprises Act (NSA) was enacted in December 2020 as part of the Consolidated Appropriations Act, 2021, and became effective January 1, 2022. Although the NSA addresses various issues, Congress’ primary objective for the NSA was to create a federal solution to the problem of “surprise medical billing” that may occur when patients with commercial health coverage unintentionally or unknowingly receive out-of-network health care services. The NSA prohibits surprise billing, so all individuals with commercial health coverage are protected against the potential financial burden of receiving out-of-network health care services, which is how surprise billing most frequently occurs. The NSA also created an obligation on the part of the health plan or health insurance issuer (referred to hereinafter as a “health insurer”) to pay providers directly for out-of-network services subject to the NSA, along with a payment dispute mechanism for providers to challenge the amounts health insurers paid for their services.

ARTICLE TAGS

• Payers, Plans, and Managed Care Practice Group
• Health Insurance