fbpx
Insurica
Pay Now
Client Login

No More “Surprises” for Patients

A surprise medical bill, also known as a balance bill, occurs when a provider bills a patient for the difference between the amount the provider charges and what the patient’s insurance pays. This usually occurs when a patient has PPO coverage and unknowingly goes to an out-of-network provider — for instance, when they need to be transported in an ambulance or receive treatment at an out-of-network hospital. Some patients might even get surprise bills even though they used an in-network facility because the care they received at the in-network facility was from an out-of-network doctor.

The “No Surprises Act” takes effect beginning Jan. 1, 2022. Patients only pay what they would have paid if their care had been performed in network. Insurers and the out-of-network medical providers must work out a compromise within 30 days. If that’s not possible, unsettled bills can enter arbitration.

There’s disagreement on the possible effects of the act. The Congressional Budget Office estimates that the act’s provisions will reduce premium growth by 0.5% to 1%, while the Centers for Medicare & Medicaid Services believes premiums will slightly increase.

Copyright © 2020 Smarts Publishing

About the Author

INSURICA
INSURICA

Share This Story

Stay Updated

Subscribe to the INSURICA blog and receive the latest news direct to your inbox.

Subscribe to the blog

Related Blogs

Preparing for Freezes: Protecting Your School During Cold Weather

January 17th, 2025|Blog, Education, News|

Preventing Frozen Pipes in Schools is essential to maintaining a safe and operational learning environment during cold weather. Frozen and burst pipes can cause costly damage, disrupt daily activities, and compromise the safety of students and staff. By taking proactive steps, schools can effectively mitigate these risks and ensure their facilities are prepared for freezing temperatures.

Cyber Case Study: Hack at Steel Mill Causes Physical Damage

January 16th, 2025|Blog, Risk Management, Trending|

 In late 2014, the German Federal Office for Information Security (BSI) released a report detailing a disruptive cyber attack at an unnamed steel mill facility. The attack—which was deployed through a combination of social engineering tactics and malware— compromised several of the steel mill’s industrial control components. From there, equipment breakdowns and production outages ensued, resulting in extensive property destruction.

Go to Top