Starting on January 1, 2022, the No Surprises Act will become law. In our recent webinar, the “No Surprises Act: Employee Impact & Broker Fee Disclosure,” Mployer Advisor CEO & Founder Brian Freeman sat down with James Bristol and Stacy Hooper of Waller, a Nashville, Tennessee-based law firm.
Here are five key takeaways from their insightful conversation.
Currently, insurance carriers set a benchmark payment for the specialty or service provided, but the providers arbitrate to negotiate the rate. The bill is then sent to the participant, the plan picks up the portion of the bill it is contractually obligated to pay and the patient is left in the middle with the gap. Once the No Surprises Act goes into effect, the participant will no longer receive a bill for the gap in what the provider expects to receive and what the plan expects to pay.
Balance billing primarily affects people on employer-sponsored healthcare plans. The new law applies to all emergency services and nonemergency service situations. This can include air ambulance transportation and E.R. visits; ancillary services such as those provided by radiologists, anesthesiologists, and pathologists; and specialty services like those delivered by a neonatologist or cardiologist. According to Hooper, over a 10-year period the average working American household will incur $2,000 in unexpected out-of-pocket expenses.
The dispute resolutions process involves the payor and provider arbitrating a price if they cannot agree to one within the 30-day negotiation window. If a number is not decided within those 30 days, both parties will throw out a number, and the arbitrator will pick one or the other.
It is important for brokers to communicate with employers that although their plan costs will likely increase, in exchange, they are receiving a more accurate number.
During the webinar, Hooper noted: “It may be helpful for participants to understand that in exchange for increased costs, they are getting more certainty that the amount for deductibles and out-of-pocket limits on their annual enrollment materials will be closer to what they will actually pay.” The panelists also agreed that employers should be in a better position than before, even if the road ahead is a little bumpy at the start.
Employers should begin to receive a fee disclosure in advance of the fees being charged. A reasonable standard is 60 days; however, if you do not receive a disclosure, then employers will have 30 days to notify the broker and inquire about the disclosure’s status. If the broker still fails to deliver the disclosure, employers can choose to enforce by reporting the broker’s failure to comply with the U.S. Department of Labor.
During the webinar, Bristol advised employers: “You can't just rely upon the brokers to do everything; you're going to have to turn around and make sure they're in compliance at least in some level.”
Overall, Hooper and Bristol recommend that brokers:
Hooper and Bristol also recommend that employers:
Eager to learn more? Click here to watch our free, on-demand webinar for a full breakdown of what brokers and employers need to know about this upcoming legislation and its implications throughout the industry.
Looking for more related content? Check out our conversation with Mployer Advisor Founder and CEO Brian Freeman for his predictions about the No Surprises Act.
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