No Surprises Act Explained

The No Surprises Act Went Into Effect on January 1, 2022.

Approximately 20% of ER Visits and 9%-16% of Hospitalizations Results in a Surprise Out-of-Network Medical Bill to Patients.

The No Surprises Act Requires Health Insurance Companies to Apply Out-of-Network Bills to Member's In-Network Deductible and Co-Insurance.

The No Surprises Act Also Requires Out-of-Network Doctors to Not 'Balance-Bill' Patients for Any Additional Payment.

The No Surprises Act States that Insurance Companies and Providers Must Negotiate a Payment Amount for Out-of-Network Bills Using the Qualifying Payment Amount (QPA) as Guidance.

The QPA is the Medical In-Network Allowed Amount an Insurance Company Pays Providers for a Medical Service in a Particular Geographic Area.

The Texas Medical Association Recently Sued Regarding the QPA and a Federal Judge Sided with them Saying that the QPA Cannot be the Sole Determinant of the Amount Paid by the Insurance Company to the Provider.

Sources:
https://www.statnews.com/2022/02/23/f...

https://energycommerce.house.gov/news...

https://www.kff.org/health-reform/iss....

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