The No Surprise Act & Price Transparency in Healthcare: How the Upcoming Healthcare Reforms Will Benefit Consumers

NEW YORK, December 10, 2021 (Newswire.com) - Credello: Many patients receiving healthcare services in the US have no idea how much it costs. And that lack of transparency can lead to surprise bills that show up at your door weeks or months after receiving care. The good news is the No Surprises Act, which will be effective Jan. 1, 2022, is designed to protect consumers from these types of surprise bills. Here's what you need to know about the No Surprises Act, the Transparency in Coverage Rule, and how upcoming healthcare reforms will benefit consumers. 

What is the No Surprises Act? 

The No Surprises Act, which is part of the larger 2021 Consolidated Appropriations Act, is designed to protect consumers from surprise bills. Many of these bills result from emergency situations where consumers are forced to use out-of-network care. The act makes it illegal for providers to bill their patients more than they would for in-network cost-sharing, except for ambulance transport by ground. 

This kind of surprise billing could happen when a patient receives emergency care at an in-network facility by an out-of-network provider. And in an emergency situation, typically, the patient is not in a position to request care from in-network providers, nor may it be accessible depending on the circumstances. 

How Does the No Surprises Act Protect Consumers? 

The act provides several consumer protections, including: 

• Healthcare providers must cover emergency services rendered by an out-of-network provider without preauthorization. 
• The cost-sharing requirement for any out-of-network services may not be greater than those that would apply for a participating provider. 
• Any consumer payments applied for these emergency services will be counted toward the participant's in-network deductible and out-of-pocket maximums. 

The Benefits of the No Surprises Act for Consumers 

The primary benefit of this act for consumers is that they'll no longer run the risk of massive surprise out-of-network bills if they've received emergency care or been transported by an air ambulance. And that means consumers who may already be facing extensive medical debt now have the space to get their debt under control without piling extra surprise charges on top. 

If you're looking to deal with medical debt, a popular way to quickly repay what is owed is through medical debt consolidation. If you have a high credit score that can qualify you for a lower interest loan, debt consolidation for medical bills could be an option to consider. 

What is the Transparency in Coverage Rule? 

The Transparency in Coverage Rule aims to give consumers greater access to their medical information. Effective Jan. 1, 2022, the rule requires health plans and insurers to grant online access to information like: 

• Negotiated rates for covered services between the health plan and in-network providers. 
• In-network negotiated rates and prices for covered prescription drugs at a particular pharmacy location. 
• Historical payments and charges for out-of-network providers. 

How the No Surprises Act and Transparency in Coverage Rule are Increasing Transparency 

There are several key ways in which the No Surprises Act and Transparency in Coverage Rule help to increase transparency in healthcare: 

• Providers and insurers must give consumers good-faith cost estimates before medical services are rendered. 
• Provider directory information must be kept up-to-date by both insurers and providers. 
• Insurers must disclose in- and out-of-network deductibles and out-of-pocket maximums. 

The government anticipates that this legislation will help consumers better evaluate care options, negotiate better rates, and decrease the cost of medical care. 

Source: Credello