Lexology January 18, 2021
The Consolidated Appropriations Act (CAA), signed December 27, 2020, will bring significant changes to group health plans in 2022. This client alert addresses the three situations in which the “No Surprises Act” included in the CAA will end surprise medical billing.
WHY DO PARTICIPANTS GET SURPRISE MEDICAL BILLS?
When a participant receives items or services from a nonparticipating provider, the nonparticipating provider is free to bill whatever amount it chooses for those items or services. Of course, because there is no contract, the participant’s group health plan is not required to pay the nonparticipating provider’s billed charge. Just like the nonparticipating provider can choose the amount it bills, the group health plan can choose the amount it pays. A...