The No Surprises Act intends to prevent patients from receiving unexpected bills for out-of-network care in emergency and select non-emergency settings. These requirements:

• Prohibit balance billing (billing a patient for the difference between the total cost of services being charged and the amount the insurance pays) for out-of-network emergency services and out-of-network non-emergency services provided at in-network facilities
• Require health plans to cover emergency services without prior authorization, regardless of whether the provider is in or out-of-network
• Require the health plan to cover the services as if they were in-network when emergency services are rendered by an out-of-network provider
• Require uninsured individuals receive a “good faith estimate” of total expected charges for a service before they receive the service
• Require providers to display public notices regarding the Act’s balance billing restrictions
• Prohibit out-of-network providers to balance bill the patient for non-emergency services rendered at an in-network facility.

The Act does not apply when patients are insured through government programs such as Medicare, Medicaid, or Tricare.

The regulations governing the No Surprises Act were issued over a fourteen-month period via two Interim Rules and one Final Rule. Due to the fragmented rule-making, providers faced significant challenges in interpreting and implementing the Act’s requirements. As a result, the Office of Healthcare Compliance and Privacy would like to thank the UConn Health Clinical Business Services and the Epic Revenue Cycle Departments for their work in implementing the Act’s many requirements.

 

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