The “No Surprise” Act is a crucial piece of legislation designed to protect patients from unexpected and often exorbitant medical bills. This act aims to address the issue of surprise billing, which occurs when patients receive medical care from out-of-network providers without their knowledge or consent.
The No Surprise Act in Arkansas is a state-level implementation of the federal legislation enacted to safeguard patients from surprise billing. It ensures that individuals who receive medical care from out-of-network providers are protected from unexpected and potentially burdensome bills. The core purpose of the act is to establish fair and transparent billing practices that provide patients with vital information about the costs associated with their healthcare services upfront.
For a free case review with our Arkansas personal injury attorneys, contact us today at (479) 316-0438.
Understanding the No Surprise Act in Arkansas
Starting in January 2022, Arkansas implemented the No Surprise Act to safeguard patients when receiving healthcare services. The act enforces billing protections for emergency care, non-emergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers.
When seeking medical care, individuals might encounter out-of-network providers who charge them more than their healthcare plan is willing to cover. That is where our Bella Vista, AR personal injury attorneys can step in to determine exactly what you owe. The additional charges the patient is responsible for paying are known as balance billing. Unfortunately, this can result in a surprise bill, which can be quite unexpected and financially burdensome.
With the implementation of the new rules, patients can rest assured that high out-of-pocket costs will be restricted, and emergency services will continue to be covered without any prior authorization, irrespective of whether the provider or facility is in-network or out-of-network. This measure aims to protect patients and ensure that they are not burdened with unexpected bills while receiving necessary medical care.
Prior to the No Surprises Act, patients with health coverage who received care from out-of-network providers were often left with higher costs than if they had utilized an in-network provider. This was especially common in emergency situations, where patients might not have had the ability to choose their providers. Even when seeking care at an in-network hospital, patients might have received treatment from out-of-network providers, leading to higher costs.
What Protections Does the Arkansas No Surprises Act Provide?
As mentioned, the No Surprises Act aims to eradicate the issue of unexpected bills for covered emergency out-of-network services and non-emergency services at an in-network facility. This law intends to provide protection to individuals who have health insurance plans, including self-insured health plans offered by employers, as well as plans from health insurance companies. Apart from the primary goal of eliminating surprise bills, there are several other safeguards that this act provides to ensure the welfare of patients in Arkansas:
Copays and Deductibles
If you ever find yourself in an emergency and need medical attention from an out-of-network hospital or medical provider, you do not have to worry about being charged more than your in-network copays or deductibles. This is because healthcare regulations mandate that such facilities are not allowed to bill you more than what you would pay for in-network emergency services.
However, it is important to remember that if your healthcare plan requires you to pay copays, coinsurance, or deductibles for in-network medical care, you are still responsible for those costs.
Good-Faith Estimate Requirement
Patients who do not have insurance coverage or are paying for their own medical treatment have the right to receive a good-faith estimate. If the healthcare service is scheduled at least three business days before it is provided, the good faith estimate must be given within one business day after the appointment is made. If the healthcare service is scheduled at least ten business days before it is provided, the good faith estimate must be given within three business days after the appointment is made.
The good-faith estimate must include a complete list of items and services the healthcare provider expects to provide during the patient’s treatment, along with the relevant diagnosis and service codes. Moreover, the estimate should specify the anticipated costs associated with each item or service every healthcare provider provides.
Services from Out-of-Network Providers at In-Network Facilities
Under the No Surprises Act, you are also safeguarded when you receive non-emergency medical services from out-of-network healthcare providers at in-network facilities. This means that if you undergo covered services at an in-network facility but are assisted by an out-of-network provider, you cannot be charged more than what you would pay for in-network copays or deductibles. This provision ensures that you are not subjected to unexpected and excessive medical bills.
Waiving Your Protections
Under certain circumstances, you might choose to receive medical treatment from an out-of-network provider. For instance, you might opt for an out-of-network surgeon even if it means the cost will be higher than that of an in-network one. However, you cannot be asked to give up your protections and agree to pay more for out-of-network care provided at an in-network facility, especially for emergency medicine, anesthesiology, pathology, diagnostic services, and services provided by surgeons.
In cases where you agree to receive treatment from an out-of-network provider, the provider is required to furnish you with information ahead of time detailing your share of the costs. Accordingly, you will be expected to pay the balance bill, as well as your out-of-network coinsurance, deductibles, and copays.
What Happens if the No Surprises Act is Violated in Arkansas?
Arkansas healthcare providers who fail to comply with the No Surprise Act could face severe consequences, including fines, suspension, or even revocation of their license to practice. The law also prohibits providers from charging patients for surprise bills that exceed the amount they would have paid if they had received care from an in-network provider.
If you receive a surprise bill that you believe violates the new law, you have several options available to you. You can appeal the decision with your insurance provider or request an external review of the decision. You can also file a complaint online with either the Arkansas Insurance Department or the federal Department of Health and Human Services here.
To resolve disputes between patients, providers, and insurers, the No Surprise Act establishes an independent dispute resolution (IDR) process. This process ensures a fair and impartial evaluation of payment disputes, which prevents patients from being burdened with exorbitant bills because of out-of-network care. Overall, the No Surprise Act provides patients with greater protection and helps ensure they are not financially exploited by healthcare providers.
Our Arkansas No Surprise Act Lawyers Can Help Answer Your Medical Billing Questions
Call our Carroll County, AR personal injury attorneys at (479) 316-0438 to receive your free case assessment today.