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Naviguard
 * Patients
 * Employers
 * Providers

 * Home
 * About Us
   * Careers
   * FAQ
   * Reviews & Testimonials
 * Resources
 * The No Surprises Act
   * NSA for Patients
   * NSA for Employers
   * NSA for Providers
 * Contact Us
 * Track My Case


WHAT YOU NEED TO KNOW


THE NO SURPRISES ACT

The No Surprises Act (NSA) went into effect on January 1, 2022 and will have
implications for patients, employers, health plans, and providers. The law
prohibits medical balance bills for many – but not all – out-of-network (OON)
services when the member cannot control where or who they receive care from.





WHAT THE NSA COVERS


THE NO SURPRISES ACT FOCUSES ON THREE MAIN AREAS:


1

Prohibits surprise medical billing for out-of-network emergency and air
ambulance services.

2

Prohibits surprise medical billing for services performed by out-of-network
providers at an in-network facility.

3

Establishes a dispute resolution process for providers and insurers.


WHAT THE NSA DOES NOT COVER


NOT ALL SITUATIONS ARE COVERED BY THE NO SURPRISES ACT.

In general, if a patient chooses to receive care out-of-network, The No
Surprises Act will not apply.

So, if you choose to see a doctor or specialist who is not in-network, The No
Surprises Act and its protections will not apply, and you may face much higher
costs than if you chose a network provider.

The No Surprises Act also does not protect patients from balance billing for
ground ambulance services, or when the law’s notice and consent requirements are
met.




NSA BY THE NUMBERS





45%

45% of Americans worry that a major health event will bankrupt them.*

70%

70% of out-of-network medical bills come from situations that won’t be covered
by the No Surprises Act.^



40%

More than 40% of people who received an out-of-network bill report costs over
$500.*

View Sources

* Source: KFF.org
^ Based on UHC commercial claims data from 2020-2021.


WHAT THE NO SURPRISES ACT MEANS FOR PATIENTS, EMPLOYERS AND PROVIDERS.

Learn more about how the No Surprises Act affects patients, employers, and
healthcare providers.


NO SURPRISES ACT FOR PATIENTS





NSA for Patients


NO SURPRISES ACT FOR EMPLOYERS





NSA for Employers


NO SURPRISES ACT FOR PROVIDERS





NSA for Providers
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NAVIGUARD CAN HELP

Naviguard provides a better solution for complex out-of-network billing. Our
deep industry knowledge positions us to understand and explain this new
legislation from the point of view of patients, employers, providers and
insurers.

We have helped over 30,000 patients and saved our members over $20 million on
their out-of-network medical bills. We are here to help providers and health
plans work through the new requirements and administer them appropriately for
their facilities, patients, and members.




VIDEO: NO SURPRISES ACT OVERVIEW

What is the No Surprises Act, how does it work, and how can Naviguard help?
We break it down for you here.

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WEEKLY DOSE PODCAST: TAKING THE SURPRISE OUT OF SURPRISE MEDICAL BILLS

One of the most important pieces of health care legislation was signed into law
last December. The No Surprises Act was designed to protect consumers from
surprise medical bills, those medical bills that come unexpectedly and often
with high price tags. But heading into 2022, hospitals and insurers are still
trying to determine how to implement the legislation’s requirements. So what’s
at stake with the legislation? And how does it affect patients, hospitals and
insurers?

Michael Wentzien of Naviguard and Lisa McDonnel of UnitedHealthcare explain in
this week’s episode.




NO SURPRISES ACT FAQS

WHAT IS THE NO SURPRISES ACT?

The No Surprises Act prohibits out-of-network providers from pursuing members
directly for medical balance bills in situations where the patient has little or
no control over who provides their care. This includes all emergency services
(except ground ambulances), or when an out-of-network provider is involved in
their care while they are at an in-network facility. As a result, patients will
be protected from balance bills in most situations where they have little or no
control over who provides their care.

However, the No Surprises Act does not apply if the member chooses to receive
items and services from an out-of-network provider. The law also does not apply
for ground ambulance services, or when the law’s notice and consent requirements
are met for certain non-ancillary services provided at in-network facilities.

The No Surprises Act also establishes an Independent Dispute Resolution (IDR)
process, also referred to as arbitration, to resolve disputes between OON
providers and insurers/health plans.

WHAT DOES THE NO SURPRISES ACT MEAN FOR PATIENTS?

Under the law, effective upon plan years beginning on or after January 1 2022,
out-of-network providers are prohibited from pursuing members directly for
balance medical bills in situations where they have little or no control over
who provides their care, like for all emergency services (except ground
ambulance), or when an out-of-network provider is involved in their care while
they are at an in-network facility.

If a patient receives a service that is covered by the No Surprises Act, the law
caps the patient’s cost share to what it would be if the services were provided
in-network.

WHEN ARE PATIENTS PROTECTED FROM BALANCE BILLS?

Patients are protected from balance bills when they receive:

 * Out-of-network emergency services, including air ambulance (but not ground
   ambulance)
 * Covered medical items and services performed by an OON provider at an INN
   facility (unless non-ancillary services and the provider follows the notice
   and consent process ).
 * Out-of-network non-emergency, ancillary services* provided at in-network
   facility.
 * Non-emergency, non-ancillary services provided at in-network facility, and
   the provider did not get your prior consent in the way the No Surprises act
   requires.

 

And, for the above services, your cost-share (in other words, your coinsurance,
copay, deductible):

 * Is the same as it would have been if the service was provided
   in-network.Counts toward your in-network deductible.
 * Counts toward your out-of-pocket maximum.

 

*Ancillary services include services related to emergency medicine,
anesthesiology, pathology, radiology and neonatology; certain diagnostic
services (including radiology and laboratory services); items and services
provided by other specialty practitioners; and items and services provided by an
out-of-network provider if there is no in-network provider that can provide that
service.

WHAT ARE THE OUT-OF-NETWORK LAWS IN MY STATE?

You can find an explanation of what out-of-network laws are currently in place
in your state here.

The law may not pre-empt state balance billing laws that establish a process for
determining OON reimbursement for covered items and services for insurers
subject to the state’s law.

WHEN DOES THE NO SURPRISES ACT GO INTO EFFECT?

The No Surprises Act is effective for plan years when they commence on or after
January 1, 2022.  Therefore, if a plan renews during 2022, the No Surprises Act
will go into effect on the renewal date.

For example, if a plan year commences on December 1, 2022, the No Surprises Act
will go into effect on that date.

HOW IS THE NO SURPRISES ACT ENFORCED? ARE THERE PENALTIES?

Insurer and health plans: provisions applicable to insurers and health plans are
enforced by the applicable federal agency (the Departments of Health and Human
Services, Labor, and the Treasury).

Providers and facilities: provisions applicable to health care providers and
facilities are enforced by the Department of Health and Human Services which may
impose fines of up to $10,000 per violation.

States: provisions applicable to providers and facilities (including air
ambulance) may be enforced by the states.


CONTACT US


WE’RE HERE FOR YOU.

Have a question for Naviguard or want to learn more about our out-of-network
medical bill services?

LET’S CONNECT

Naviguard
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 * Track My Case

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Naviguard is a member of the Nationwide Multistate Licensing System & Registry.
NMLS # 2051222
© 2022 Naviguard, Inc. Naviguard is a trademark of Naviguard, Inc.


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 * Patients
 * Employers
 * Providers

 * Home
 * About Us
   * Careers
   * FAQ
   * Reviews & Testimonials
 * Resources
 * The No Surprises Act
   * NSA for Patients
   * NSA for Employers
   * NSA for Providers
 * Contact Us
 * Track My Case