No Surprises—A Provider Primer for Uninsured Patients
Effected January 1, 2022, uninsured or self-pay patients are protected from unexpectedly high medical bills. To patients who don’t have any health insurance or don’t want to use insurance for health care services or items, medical service providers must provide a ‘good faith estimate’ that includes an approximate cost covering all medical services that a patient wants to take.
This is more commonly known as ‘No Surprises’ requirements. Regardless of any scheduled or unscheduled item, a healthcare provider or facility must provide the ‘good faith estimate’ to the patient if he/she requests it.
There is also a dispute resolution process between the patient and provider if the total health care costs exceed more than $400 than the initial good faith estimate for any reason. The patient may initiate the dispute process. In such cases, an independent third-party dispute resolution entity will investigate the entire case to determine the amount a patient needs to pay.
For any dispute, the healthcare provider needs to upload the following documents to the federal dispute resolution portal:
- The ‘good faith estimate’ they provide to the patient;
- The bill they sent to their patient;
- Any supporting documents that explain the reason behind the higher bill amount.
Bill negotiation between the provider and the patient can be ongoing during the dispute resolution process. However, some restrictions are applied to the provider as follows:
- Providers are not allowed to move the bill into collections;
- They must pause the bill if it is already in collections;
- Providers cannot collect any late fees on unpaid amounts;
- Providers are not allowed to threaten patients in any form for initiating a dispute.
The patient and the provider may come to a settlement regarding the cost before the dispute resolution entity provides its verdict. In that case, the provider must notify the issue to dispute resolution entity within 3 days of the settlement.
Providers should also fill up a settlement notice and upload it to the federal dispute resolution portal along with other supporting documents. At this point, the entire procedure is deemed complete.
