Have your employees ever asked why they were hit with out-of-network bills when they went to an in-network hospital?
A new law, effective January 1, 2022, called the No Surprises Act is aimed to provide healthcare consumer protection against unexpected bills and cost shares. As with most legislation, there are many moving parts and complexities. A recent article released by Kaiser Family Foundation (KFF) does an excellent job outlining the law in greater detail. My goal here is to highlight the areas employers can support their employees as they access the healthcare system.
The law is somewhat limited in its application. The applicable types of services/claims are limited to Emergency Services, Emergency Transportation (Air Ambulance), Out-of-Network Providers working in In-Network Facilities, and Post-Emergency Stabilization.
Think about 2 scenarios:
1. An individual is injured severely at a remote location. They call 911. A helicopter arrives to transport the individual to an emergency room that can accommodate the helicopter. S/he receive emergency and stabilization services via the emergency room. Previously, if any of these services were not in-network with the individual's health plan, s/he was subject to out-of-network cost share (deductible, copays) or no coverage at all. In theory now, the default application is to make the services allowable under the individual's in-network coverage.
2. An individual is planning an elective surgery (non-emergency). S/he do all their pre-services with a known in-network physician and plan the surgery at an in-network facility. However, not disclosed to the individual is a service like radiology or anesthesia are contracted by the facility, but are out-of-network. Previously, the individual would be subject to out-of-network cost shares by those services. In theory now, the default application is (a) disclosure by those providers and (2) in-network cost shares.
What can employers do?
/ Communicate the highlights of this new law to employees.
/ Encourage employees to ALWAYS review medical bills for accuracy. If they see any unexpected charges or applied cost shares, they should contact their employer or broker to review.
/ A section of the law allows (but does not require) for individuals to waive these protections, individuals should consider those waivers very carefully.
/ Train employees on how to read medical bills and explanation of benefits (EOBs)