NO SURPRISES ACT

NO SURPRISES ACT

What is the No Surprises Act?

The No Surprises Act was passed by Congress in 2020 to help alleviate the problem of patients receiving an unexpected bill in an emergency situation or when they are out-of-network. On January 1, 2022, new provisions of the Act go into effect.

What is Surprise Billing?

When a person with a group health plan or health insurance coverage gets care from an out-of-network provider, their health plan or issuer usually does not cover the entire out-of-network cost, leaving them with higher costs than if they had been seen by an in-network provider. In many cases, the out-of-network provider can bill the person for the difference between the billed charge and the amount paid by their plan or insurance, unless prohibited by state law. This is known as “balance billing.” An unexpected balance bill is called a surprise bill.

How does that impact me?

The new provisions of the No Surprises Act forbid balance billing in certain situations involving out-of-network care or emergency care, and require that self-pay patients receive an estimate for certain scheduled services at or near the time of scheduling.

How will Kansas Medical Clinic handle out-of-network situations?

To help ensure patients are seen in network, Kansas Medical Clinic providers will proactively help direct patients to an in-network provider or facility whenever possible. Please see our contracted insurers to see if your insurance is in network with Kansas Medical Clinic.

Why did I get an estimate for future services?

The Act requires that self-pay patients (patients without insurance, patients with medical sharing ministry plans or patients not planning on filing their charges to their insurance company) be sent an estimate within 1-3 days of scheduling their appointment. Estimates will be sent to patients via patient portal or mailed to the patient. Please indicate a preference at the time of scheduling if you have one.

What if I don’t plan on having my charges filed to my insurance company for my upcoming visit?

If you don’t plan on having your charges filed to your insurance carrier at your visit, please indicate that at scheduling.

What happens if I am a self-pay patient and no estimate was sent to me?

The Act requires that we generate an estimate for you and if no estimate was sent, we are required to reschedule your visit. Our staff attempt to make sure that any self-pay patient is sent an estimate once their appointment is scheduled. However, if a patient’s insurance status changes from the time of scheduling, and prior to the visit itself, we may be unaware of the change in your insurance status. If your insurance status has recently changed to self-pay, please contact our office to make sure we send an estimate to you prior to your visit.

I am curious about what my visit will cost.  Can I get an estimate?

Sure. Please contact our office to request an estimate for your upcoming services.

What if my final billed charges are more than my estimate?

This estimated cost of anticipated care takes into consideration insurance coverage, co-payments, deductibles, coinsurance and other factors that may affect your out-of-pocket costs based on information provided by you and your insurer(s). Expected charges are estimates. Final billed charges on the bill may vary from the estimate as a result of a patient’s medical conditions; circumstances or complications; final diagnoses; or treatments ordered by a patient’s attending physicians that may need to be scheduled separately. Your estimate also does not include professional service fees charged outside of Kansas Medical Clinic, such as those provided by a radiologist, pathologist, anesthesiologist, or other independent practitioner.

If the variance between the estimate and the final bill is greater than $400 per provider, and the patient is unable to resolve their concern with Kansas Medical Clinic, the patient may initiate a Dispute Resolution Process by completing a request to Health and Human Services within 120 days of receiving billing. HHS PPDR (Patient-Provider Dispute Resolution) Entities

Estimates for patients with insurance coverage can change frequently as the patient’s remaining deductible and co-insurance change over their plan year. For that reason, for non-self-pay patients, an estimate is only valid for 30 days from the Creation Date shown on the estimate. If you have any questions regarding your estimate or when you receive your billing statement, please contact our office.