What Plans & Services Are Impacted by NSA

Government Bureaucrat Memorializes Regs

The interim final rule published in July 2021 clarified that the NSA is applicable to indemnity plans, which suggests that reference-based pricing plans would also be covered by the law.

However, the definition of surprise bills for indemnity plans is typically limited to Emergency and Air Ambulance claims. For example, if a plan has no hospital network, then there cannot be a surprise bill scenario where a member goes to a network hospital and is treated by an out-of-network professional.

Presumably, this same analysis would apply to reference-based pricing plans that do not have networks. However, the rule does state that a non-network facility is to be considered the same as a network participating facility with respect to identifying surprise bills if the plan has an individual agreement with that facility.