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Legislation Passed to Address Surprise Medical Billing

Congress incorporated into the Consolidated Appropriations Act, 2021 (P.L. 116-260) the “No Surprises Act,” which bans surprise medical bills and establishes a process for resolving payment disputes for out-of-network (OON) care. The provisions of the new law, which will be implemented on Jan. 1, 2022, meet many of neurosurgery’s principles and include the following elements:

  • Patients are protected from surprise medical bills and only responsible for the in-network cost-sharing amount for OON emergency services and other services provided in in-network facilities.
  • Insurers are required to make initial payments directly to OON providers for OON services within 30 days. The law does not define the payment rate.
  • If a provider objects to the payment, they may proceed to an independent dispute resolution (IDR) process.
  • The IDR process is baseball-style arbitration. There is no negotiation. Both parties submit a payment rate, and the arbiter selects one.
  • The arbiter may consider several factors, including median in-network rates and any other information the provider or health plan submits. However, the arbiter may not consider Medicare, Medicaid, Children’s Health Insurance Program (CHIP) and Tricare rates.