The No Surprises Act, a federal law that took effect in January 2022 and aims to make sure patients stay on the same insurance plan when moving from one provider to another, requires insurers to pay hospitals and physicians the same rates for their services regardless of whether they are in-network or out-of-network. This is a boon for consumers, but it also could mean trouble for your insurer if you are receiving QPA benefits. In this post, we will discuss what qualifies as an “outlier” payment amount under the new law and how this may impact your coverage options.
The recently passed “No Surprises Act” requires insurers to pay hospitals and physicians the same rates for their services regardless of whether they are in-network or out-of-network. This is a huge change for insurance companies, which have historically negotiated with providers based on their own financial needs.
The law also limits qualifying payment amounts by setting a minimum cap on how much an insurer can charge per service. In addition, it stipulates that if you choose an out-of-network provider, then your insurer must provide coverage under “preferred provider organization” (PPO) plans until at least 90 days after your treatment ends – even if you don’t want them covering you anymore!
Some insurers are preying on a loophole that allows them to pay some healthcare providers less than others.
The problem is that insurers have begun altering their contracts with QPA providers so as not to mention QPA altogether. This means that when an insurer has contract disputes with a provider, instead of using the QPA, which could be as much as 60% lower than the standard charges, they will use the much higher standard charges instead. Insurers can then take the savings from not paying out at the lower rate, and use it for other things like stock buybacks or dividends to shareholders.
As a result, many patients may be unaware that they are being charged more than what was initially indicated on their bills—and this could violate state laws that require transparency between patient and doctor regarding payments made by health care providers during treatment sessions (including those associated with procedures).
The No Surprises Act is a great step towards ensuring that everyone gets the care they need, regardless of insurance status. Unfortunately, it appears as though some insurers are attempting to skirt around this law by altering their contracts with QPA providers. The Act requires that providers are paid for their services upfront, rather than after the fact. Because of this, some insurance companies have been trying to get around this law by asking providers to accept payment terms. If a provider agrees, then they are essentially agreeing to provide services without knowing how much money they’ll be receiving from the insurer. This is no surprise (get it?), and it’s something the powers that be will continue to keep an eye on. The No Surprises Act was designed to prevent situations like this from happening, and continuous monitoring is required to ensure that the law is being followed.
Executive – Social Media Marketing
V-Etico Services LLC
Phone: 1 (307) 368-8003