Introduction
Introduced at the beginning of 2022, the No Surprises Act aims to protect patients from unexpected expenses, primarily while receiving emergency medical services. This law can be considered inevitable, since the problem of inadequate financial assessment of medical care was identified long ago (Zalon et al., 2019). Patients may not always be able to evaluate the healthcare provider during emergencies, as valuable time can be lost. Subsequently, patients may be surprised to find that they are responsible for expenses not fully covered by their insurance.
With the introduction of the new initiative, patients can focus on their health rather than worrying about subsequent payments. Despite the advantages of the new law, it has unobvious shortcomings that can negatively affect all interested parties. The effects of implementing the law must be assessed and considered to understand its effectiveness in protecting patients.
No Surprises Act of 2022
The No Surprises Act helps protect patients’ finances. Starting January 1, 2022, consumers have a new remedy for emergency or non-emergency care (CMS, 2022). The new rules aim to protect consumers by limiting excessive cash spending.
Previously, if consumers had health insurance and received care from an out-of-network provider, the health plan did not cover all costs (CMS, 2022). This became a severe problem in cases where the patient did not have time to choose a healthcare provider. The service provider could bill consumers for the difference between the provider’s expenses and the customer’s insurance plan; this balance sheet could come as a surprise (CMS, 2022).
With the new law, patients who choose to use out-of-network providers will be prohibited from billing patients for balances without providing notice (CMS, 2022). Patients must also agree to receive care from out-of-network providers, which may result in higher costs. Thus, a standard system is established in which insurers and providers agree on the amount to be paid, thereby protecting patients from unexpected treatment costs.
Stakeholders
The stakeholders affected by the new law are patients, healthcare providers, and the healthcare system itself. From a patient’s perspective, the law protects them from unexpected costs by requiring additional consent if they request out-of-network services. The new law may have negative consequences for healthcare providers in the form of inadequate payment for services. However, the health care system benefits in the long run as it becomes fairer and more patient-centered.
Financial Implications
In addition to the apparent benefits for protecting patients’ rights, the new law could reduce the cost of emergency medical services. Before the introduction of the No Surprises Act, average prices for emergency services fluctuated wildly between different medical institutions. Now the medical staff will have less influence on the final price due to a reduction in their role in pricing. If a hospital or doctor believes they are not receiving the required amount, they can challenge the payment and submit it to an independent arbitrator (MacDonnell, 2022).
Specialists base their assessment on average prices for a particular service, which can be significantly lower than the requested price (MacDonnell, 2022). With the introduction of the new law, decisions will be made primarily in the patient’s best interest. The law helped eliminate a glitch that would not only protect patients from unexpected bills but could also help keep prices down.
Advantages
The benefits of the new law for patients are undeniable. Patients must be further informed and allowed to consent to out-of-network care to avoid unnecessary costs. In the long term, patients can expect lower costs for emergency services.
The No Surprises Act will enhance service providers’ reputation by demonstrating a patient-centered approach. From the perspective of the general healthcare system, this law represents a step towards enhancing patient literacy by providing greater transparency in healthcare costs (Baur, 2020). In general, the new law aims to reduce costs and protect patients.
Disadvantages
Health care providers are concerned that the new law will not address the underlying problems with unexpected medical bills. Hospitals argue that the rule is insufficient to address the inadequacy of healthcare provider networks, which are crucial in preventing unexpected billing in the first place (MacDonnell, 2022). Additionally, hospitals are concerned about the urgent need to establish new financial departments, which may prove too costly (Schechter & Sklar, 2022). The new rules do not apply to every case of out-of-network care, which still leaves patients not fully protected. The healthcare system remains imperfect, and the benefits of price reductions may be too long-term to offset the costs of implementing the law.
Conclusion
The No Surprises Act ensures that patients will not bear unexpected expenses. Despite its shortcomings, this law is essential to improving medical care and patient safety. In the future, its financial implications could significantly reduce the cost of emergency care services. Ways must be found to mitigate the law’s adverse effects on healthcare providers so that the healthcare system can improve effectively.
References
Baur, C. (2020). What must health literacy stakeholders do to build a public health and population health agenda? Studies in Health Technology & Informatics, 269(1), 128-141. Web.
CMS. (2022). Ending Surprise Medical Bills. Web.
MacDonnell, T. C. (2022). Making an offer that can’t be refused: The need for reform in the rules governing informed consent and doctor-patient agreements. Vill. L. Rev., 67(1), 509-526. Web.
Schechter, R. M., & Sklar, D. E. (2022). No Surprises Act and the provider/patient/payor dynamic backdrop. American Bankruptcy Institute Journal, 41(2), 8-55. Web.
Zalon, M.L., Patton, R.M., Ludwick, R. (2019). Nurses Making Policy: From Bedside to Boardroom. Springer Publishing Company.