For far too long, our constituents have done everything right at the doctor’s office or hospital yet still found themselves stuck with surprise medical bills, sometimes to the tune of tens of thousands of dollars. And frequently, they have to fight these bills at the same time they are facing a medical crisis.” -Senator Bill Cassidy, MD

In recent years, there has been an increase in the number of people who are under-insured or uninsured. This means that they either do not have health insurance, or their health insurance does not cover all of the costs associated with their care. As a result, these individuals are often responsible for paying the entire cost of their care out-of-pocket. This can be a significant financial burden, especially for those struggling with chronic conditions like mental illness or substance use disorders.

The No Surprises Act and Good Faith Estimates can help to protect these individuals by ensuring that they do not have to pay the entire cost of their care out-of-pocket.

What is the No Surprises Act?

The No Surprises Act is a federal law that went into effect on January 1, 2022.  The No Surprises Act is a much-needed piece of legislation that will help to protect patients from surprise medical bills.

One of the key provisions of the Act is to create new rules around transparency in pricing and cost-sharing. Insurers and providers will be required to give patients clear information about their costs before receiving care. This way, patients can make informed decisions about their care and budget accordingly.

The Act will also put an end to balance billing, which is when a patient is billed for the difference between what their insurer pays and what the provider charges. This practice can often leave patients with hundreds or even thousands of dollars in unexpected medical bills. The No Surprises Act will help to protect patients from these types of surprise bills, ensuring that they are able to get the care they need without having to worry about how they will pay for it.

What are Good Faith Estimates?

Under the No Surprises Act, insurers are required to provide patients with a Good Faith Estimate of their expected share of the costs associated with their care. This estimate must be provided to the patient before they receive treatment. The Good Faith Estimate must include the patient’s deductible, co-payment, and co-insurance amounts. It must also include an estimate of the total cost of the care that the patient will receive. The Good Faith Estimate must be provided to the patient in a format that is easy to understand and compare with other estimates. Ultimately, the GFE is a valuable tool for patients navigating the complex world of healthcare costs.

The Benefits of the No Surprises Act and Good Faith Estimates

The benefits of the No Surprises Act and Good Faith Estimates are threefold:

Lower Premiums

In recent years, the cost of health care has been rising at an alarming rate. This has put a strain on both patients and their families, as well as on the health care system as a whole. One of the ways that this cost increase has been passed on to patients is through higher premiums. In some cases, these premium increases have been so high that they have made health insurance unaffordable for many people. The No Surprises Act is designed to help solve this problem by preventing health insurance companies from charging patients more than their expected share of the costs associated with their care. By keeping premiums affordable, the No Surprises Act will help to ensure that everyone has access to the care they need.

Protection for Those Who are Underinsured or Uninsured

The No Surprises Act and Good Faith Estimates can also help to protect those who are under-insured or uninsured. As mentioned earlier, the No Surprises Act prohibits health insurance companies from charging patients more than their expected share of the costs associated with their care. This means that if you have a health insurance plan that covers mental health care, your insurer cannot charge you more than your expected share of the costs associated with your care. Similarly, if you are uninsured, the No Surprises Act will protect you from being charged more than your expected share of the cost of your care. In addition, the Good Faith Estimates can help patients to budget for their care by providing them with an estimate of the out-of-pocket costs they can expect to pay.

Better Information for Consumers

The No Surprises Act and Good Faith Estimates will also help to provide patients with better information about the cost of their care. In the past, patients have often been in the dark about the true cost of their care. This is because providers often do not know the full extent of a patient’s insurance coverage until after the care has been rendered. As a result, patients are often surprised by the final bill for their care. The No Surprises Act and Good Faith Estimates will help to solve this problem by providing patients with better information about the cost of their care upfront. This will allow patients to make more informed decisions about their care, and it will help to ensure that unexpected costs do not blindside them.

What Does the No Surprises Act Mean for Providers?

The No Surprises Act will have a few different implications for providers. First, providers will be required to give patients a Good Faith Estimate of their expected share of the costs associated with their care. Second, providers will be prohibited from billing patients more than their expected share of the cost of their care. This means that if a patient’s insurance does not cover the full cost of their care, the provider cannot bill the patient for the remaining balance. Third, providers will be required to give patients a refund if they are billed more than their expected share of the cost of their care. Finally, the No Surprises Act will create a new appeals process for patients who believe that they have been incorrectly billed for their care.

Conclusion

The No Surprises Act and Good Faith Estimates are game-changers for the health care industry. By giving patients better information about the cost of their care and protecting them from unexpected costs, the No Surprises Act will help to make health care more affordable and accessible for everyone.

Stay Compliant with TenEleven

TenEleven is committed to providing our customers with the tools they need to comply with the No Surprises Act. Powerful features like our custom form builder and our interoperability platform will help you to collect the information you need to give your patients Good Faith Estimates. In addition, our bed management system and our MAT program will help you to keep track of your patient’s care and ensure that they are not being charged more than their expected share of the cost of their care. Sign up for a free demo of TenEleven – no credit card required!