No Surprises Act Effective Beginning January 1, 2022

Under the Consolidated Appropriations Act, 2021 – signed into law on December 27, 2020 – the surprise medical billing provision limits what health plan participants will pay for certain services.  Effective for plan years beginning on or after January 1, 2022, participants will not be subject to balance billing when they seek emergency care, are transported by air ambulance, or receive nonemergency care at an in-network facility but are treated by an out-of-network physician or laboratory without receiving the required notice and providing consent.  The notice-and-consent exception does not apply to providers of ancillary services, such as anesthesiologists and pathologists.

For these services, participants will be required to pay only the in-network cost-sharing amount, which must be applied to the member’s in-network deductible and out-of-pocket maximum.  Prior authorization is not allowed.

The plan must make publicly available a notice of balance-billing prohibitions and include the notice in all applicable EOBs.  ASR will provide our clients with the required notice for distribution to participants as well as ensure the notice is included with all applicable EOBs.

If you have questions about the No Surprises Act, call ASR Health Benefits at (616) 957-1751 or (800) 968-2449.