The No Surprises Act is a notable milestone in healthcare legislation. This federal statute aims to protect consumers from surprise medical bills when seeking care from out-of-network providers.
While it addresses many concerns related to surprise bills, the No Surprises Act still leaves significant gaps in coverage that employers, employees, and voluntary benefits brokers should be aware of.
In this article, you’ll see how the No Surprises Act works, understand its limitations, and explore how it applies to voluntary benefits. Then you’ll learn how Wellfleet Workplace’s benefits can provide protection in times when the No Surprises Act falls short.
What is the No Surprises Act?
The No Surprises Act (NSA) is a federal law enacted under the Consolidated Appropriations Act of 2021. It shields consumers from surprise medical bills incurred during out-of-network care situations beyond their control. At its core, the act prevents a scenario where individuals visit an in-network healthcare facility and are subsequently billed for out-of-network care from providers working within that facility.1
What are the key components of the No Surprises Act?
The act protects consumers in certain scenarios from receiving balance bills, often called “surprise bills.” Balance billing is when patients receive a bill for the monetary difference between what their insurance plan covers and what the out-of-network provider charges.
While some states already had rules to protect patients against balance billing, the NSA federally protects consumers from certain balance billing scenarios.2
Who does the No Suprises Act apply to?
The act is applicable to those who have group or individual health insurance plans.2 It applies in specific circumstances, including when a member goes to an in-network healthcare facility and is treated by an out-of-network provider. Additionally, the act applies to those who receive care from out-of-network air ambulance services and emergency rooms (not urgent care).
What are the limitations of the act?
While the NSA represents a significant leap forward in shielding consumers from the burdensome weight of some surprise medical bills, even well-intentioned legislation isn’t a complete solution. Individuals still need additional protection from unexpectedly high healthcare costs.
So, what are the weaknesses of the NSA? It falls short when applied to several essential healthcare services. This gap exposes individuals to potential financial risks when seeking specific types of care.
Here are the key types of care excluded from the NSA:
1. Ground ambulance services
One of the most notable omissions of the No Surprises Act is the exclusion of ground ambulance services. This exclusion leaves a vulnerable gap with potentially severe consequences for those in out-of-network emergency situations.
When individuals require urgent medical attention and an ambulance is dispatched, they often have no control over which ambulance service responds. Additionally, emergency medical situations are characterized by chaos and urgency, making it virtually impossible for patients to assess whether the ambulance service is in-network or out-of-network.
In many cases, the ambulance that arrives may be out of network with the individual’s medical insurance plan. In this scenario, the act of seeking lifesaving care could potentially lead to catastrophic financial burdens.
Consequently, despite the No Surprises Act’s protections against air ambulance surprise billing, individuals may nevertheless unwittingly face steep out-of-pocket expenses for ground ambulance service.
2. Urgent care
Urgent care centers provide timely medical attention for non-life-threatening conditions. However, the NSA does not explicitly apply to these facilities. Individuals seeking care at urgent care centers may still encounter out-of-network charges, particularly if the center contracts with out-of-network providers.
3. Birthing services
The Act does not extend its protection to birthing services, which can be a significant concern for expectant parents. Given the unpredictability of childbirth, individuals may not have the luxury of selecting an in-network provider for maternity care, potentially leading to unexpected bills.
4. Hospice care
Hospice care is a sensitive and essential service for individuals with terminal illnesses. The act does not address the possibility of out-of-network charges for hospice care, placing an additional burden on already emotionally strained families.
5. Addiction treatment
Amid the opioid crisis and increased attention to substance use disorders, addiction treatment is more critical than ever. Unfortunately, the No Surprises Act does not encompass this vital service, leaving individuals seeking help for addiction potentially vulnerable to surprise bills.
6. In-network costs
Healthcare costs continue to rise, and covered families in 2024 could see an out-of-pocket maximum of as high as $18,900.3
While the No Surprises Act takes a commendable stride in protecting consumers from surprise medical bills, it also leaves vulnerabilities that demand attention.
This is where insurance solutions, like those provided by Wellfleet Workplace, come in. Products like accident insurance and hospital indemnity insurance can help bridge the divide and safeguard individuals from unforeseen out-of-pocket expenses.
How workplace benefits help fill the gaps
The incomplete protection of the No Surprises Act underscores the essential role of voluntary benefits. These benefits can help to effectively fill the coverage voids that might otherwise lead to substantial out-of-pocket costs for individuals.
Here’s how Wellfleet’s voluntary benefits bridge those gaps:
Consistent reimbursement rates
Workplace benefits offered by Wellfleet pay the same amount for claims regardless of which provider they see. This means plans don’t pay different amounts based on provider networks; whether members get in-network or out-of-network care in the eyes of their medical plan, our workplace products offer consistent coverage.
These benefits also pay the same amount regardless of whether the service is covered by other insurance, including disability coverage, accidental death and dismemberment coverage, or others.
Coverage for essential services
Wellfleet’s voluntary benefits packages, including hospital indemnity and accident coverage, provide benefits that can be used to pay for essential services that the No Surprises Act leaves unprotected, including:
- Ground ambulance
- Urgent care
- Birthing
- Hospice
- Addiction treatment
When the unexpected happens, our members can focus on getting the care they need. Instead of worrying about the burden of surprise bills, they can rest assured that Wellfleet will provide protection regardless of their provider’s network status.
Partner with Wellfleet
While the No Surprises Act is a step in the right direction to protect consumers from surprise medical bills, it’s essential to be aware of its limitations. Workplace benefits from Wellfleet offer a solution that helps individuals access necessary healthcare services without fearing their out-of-pocket expenses.
Brokers play a crucial role in helping employers and employees navigate the complexities of healthcare legislation and coverage gaps. Educate your clients about the value of voluntary products and how they offer protection in the face of the unexpected. The more your clients know, the more they can educate their employees about the reasons to enroll.
To learn more about Wellfleet Workplace, reach out to our team. Together, we can help individuals access the protection they need.
Resources:
1 Centers for Medicare & Medicaid Services. Frequently Asked Questions (FAQs) about Consolidated Appropriations Act, 2021 Implementation – Applicability, Notice and Consent. https://www.cms.gov/files/document/cciio-nsa-faqs.pdf.
2 Centers for Medicare & Medicaid Services. (2022, April 6). Frequently Asked Questions For Providers About the No Surprises Rules. https://www.cms.gov/files/document/faq-providers-no-surprises-rules-april-2022.pdf.
3 Centers for Medicare & Medicaid Services. Out-of-pocket maximum/limit. https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/
