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Additional Regulations Issued on Surprise Medical Billing Ban

Oct 19, 2021 Decorative image

The Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury (Departments) jointly released additional guidance regarding implementation of the No Surprises Act, enacted as part of the Consolidated Appropriations Act, 2021, signed into law in late 2020.

Surprise Medical Bills

Surprise medical bills occur when patients unexpectedly receive care from out-of-network health care providers. Patients often cannot determine the network status of their providers during treatment to avoid the additional charges. In many cases, the patient is not involved in the choice of provider at all.

Most Recent Guidance

On September 16, 2021, the Departments published a proposed rule regarding air ambulance services reporting. Providers of air ambulance services will need to submit cost and organizational data as well as other transport-level data related to air ambulance services. Additionally, group health plans will be required to report information relative to each air ambulance claim received and/or paid during two consecutive one-year periods scheduled to begin in 2022.

On October 7, 2021 the Departments published an interim final rule describing the federal arbitration process, which is the independent dispute resolution (IDR) process that providers, facilities or providers of air ambulance services, and health plans or issuers will use to determine final payment beyond allowable patient cost sharing for certain out-of-network health care services in situations where the No Surprises Act prohibits surprise billing. The rule also requires certain providers and facilities to provide a good faith estimate of the charges to uninsured individuals so that they can anticipate their costs when seeking health care.

More Information

Reach out to your Hylant representative for further information. Don’t have one? Contact us here.

The above information does not constitute advice. Always contact your employee benefits broker or trusted adviser for insurance-related questions.