What is the No Surprises Act? “It’s a law that transfers balance billing liability from plan members to plan sponsors under certain circumstances gifting the balance biller a much better opportunity to recoup from a deep pocketed plan sponsor than from a Joe Sixpak.” Bill Rusteberg
“Historically, patients who were unexpectedly treated by a provider that did not accept their insurance often received “surprise” out-of-network bills. The No Surprises Act (NSA) has successfully shielded patients from most forms of surprise out-of-network bills by requiring insurers to apply only in-network cost-sharing in these cases and barring providers from “balance billing” patients for additional amounts.”
“However, experience with the arbitration system designed to determine what insurers must pay providers in these cases has been less encouraging. Arbitration volumes have been high, generating large and wasteful administrative costs. Likely related, decisions have varied widely from arbitrator to arbitrator, even for similar cases. These challenges were predictable and hold lessons for future policymaking.”
We are seeing a lot of emergency room activity since passage of the No Surprises Act. Plan members know they can go to the ER at any time, day or night, receive same day care on demand and never have to worry about a balance bill. Hospitals are taking advantage of this. You can’t blame them. Recently we received a $25,000 ER visit bill from Valley Baptist Hospital in Harlingen, Texas. Medicare allowable is <$1,000. We received another ER bill of >$35,000 from another hospital. This is an evolving strategy, to aim high, roll the dice with odds that would make even the bookies in Las Vegas blush with envy.
