What Is The No Surprises Act?

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What Is The No Surprises Act?


The American public knows that unexpected healthcare expenses can turn someone’s life upside down. When receiving ongoing medical treatments or when visiting the emergency room unexpectedly, we hope for transparency in the billing process.

This is where the No Surprises Act can help keep Americans from acquiring unexpected healthcare costs. Whether you are an everyday American curious about the law or a healthcare provider unsure of how the new No Surprises Act might affect you, the healthcare accountants at Interactive Accountants want to help you understand the specifics of the law.

The Burden of Medical Debt

The unfortunate reality is that in the United States, everyday people have carried the burden of debt related to necessary medical treatments. A June 2022 study by the Kaiser Family Foundation cites an estimated 100 million Americans are currently living with medical debt.

Surprise healthcare debt affects all demographics and backgrounds of people– even wealthy families have been saddled by the cost of surprise medical bills from out-of-network providers they did not choose for themselves. Surprise medical debt does not discriminate and can change a person’s life no matter their financial situation.

The No Surprises Act protects the American people and medical consumers from unexpected bills related to medical treatments.

Overview of the No Surprises Act

For many people in this county, even those that make a high salary, an unexpected medical bill can bring many complications into the picture. The purpose of the No Surprises Act is to remove this shock from continuing to affect the lives of the American people.

Who is Affected by the New Law?

Some important information to note is that the No Surprises Act covers both those on group insurance plans and individual plans. Additionally, even for those without health insurance, the No Surprises Act requires medical care facilities to provide a list of expected charges for those that plan to self-pay.

For these insured and uninsured individuals, this is a “good faith estimate” that a medical provider will give you a realistic and likely purview of the expenses related to treatment(s) before services are rendered.

The law affects all Americans regardless of what state they live in– while the No Surprises Act is a federal law, states do still have the option to add onto the law as long as those additional measures meet the general parameters of the bill. The reason for this is that different states use different major insurance companies. For example, the most common type of health insurance plan Americans use is a PPO plan. There are variations to this and depending on the state and insurance company, the time required to file the necessary paperwork can vary.

What Are Surprise Medical Bills?

Sometimes receive medical treatment from in-network providers, but when the insurance company receives the details from the provider, your coverage is denied. This can happen if any out-of-network providers were in any way connected to your treatment or if you were administered any treatments that are not covered by your specific plan.

For example, if you chose an in-network provider for a surgery that was to be covered by your insurance provider, but the anesthesiologist working for the hospital is an out-of-network provider, your insurance company will expect you, as the patient, to cover that cost.

Surprise medical bills are expenses related to your medical health screenings and treatment plans that were not explicitly stated as a cost to you. Thanks to the new No Surprise Act, out-of-network providers are banned from billing patients any costs that exceed their in-network, approved amounts.

How Will the No Surprises Affect Healthcare Providers?

As a healthcare provider, it is important to know the rules that apply to you regarding the No Surprises Act. Penalties for not adhering to this act can be large. When it comes to the medical world, information is the most powerful tool you can have in your arsenal to help save yourself from unnecessary costs.

Working with an experienced healthcare accountant who understands the language, laws, and record-keeping procedures of medical professionals can make an impact on saving you money and time. When it comes time to file your taxes for your business, it’s vital that you have the guaranteed peace of mind that you are adhering to all HIPAA laws when it comes to documentation of your practice’s records and how they are affected by the No Surprises Act.

Schedule a Free Consultation with a Healthcare CPA

Are you a healthcare provider looking for a certified public accountant with experience in medical accounting? Matthew Shiebler is a CPA with over 25 years of experience in preparing tax and financial documents for professionals in the medical field.

With attention to detail, advanced knowledge, and a focus on customer support, Interactive Accountants understands the unique challenges healthcare professionals face when it comes to up-to-date, HIPAA-compliant practices of planning, keeping, and reporting financial records.

Call us today at (305) 517-3977 or schedule a free consultation with our healthcare CPA today!