No Surprises Act: New Law Protects You From Certain Surprise Medical Bills and Improves Price Transparency
The No Surprises Act of 2020 provides you with significant protections from surprise billings charged by non-network providers in the three situations listed in the graphic on the left. It also provides pricing transparency that will make it easier for you to comparison shop for medical services. These and other components of the law take effect January 1, 2022.
Listed below are components of the No Surprises Act you can expect to see, beginning January 1, 2022. For complete details on Health Plan changes taking effect January 1, 2022 in response to the law, refer to the March 2020 Health Plan Summary Plan Description and its updates available at www.dgaplans.org/health-plan-booklet.
Summary of Changes Coming January 1, 2022
Under certain circumstances, non-network providers and facilities will be banned from balance billing amounts not covered by insurance, and your cost sharing will be the same regardless of whether the services are provided by a network or non-network provider or facility. Group health plans and insurers—including the DGA–Producer Health Plan (“Health Plan”)—will be required to cover services with the same participant cost sharing whether the services are provided by a network or non-network provider or facility under the following three circumstances:
- Emergency services provided at a non-network facility,
- Services/items provided by a non-network provider at a network facility, or
- Non-network emergency air ambulance services.
Non-network providers and facilities may not bill you for any amounts not covered by the Health Plan in the three circumstances above.
However, you may consent to treatment from a non-network provider and billing at the non-network rate.
You may consent to be treated for non-emergency services by a non-network provider at a network facility, and such services will be covered at the non-network level if certain conditions are satisfied. Refer to the March 2020 Health Plan Summary Plan Description and its updates for details.
If you consent, you will be responsible for payment of the applicable non-network co-insurance as well as any amount above the Reasonable and Customary amount (Refer to the March 2020 Health Plan Summary Plan Description, Health Plan Terms section, page 40 for more information on Reasonable and Customary).
Medical coverage ID cards must include more information.
Beginning January 1, 2022, your medical coverage card must include the following: your plan’s deductible amount, out-of-pocket limits, and a website address and phone number where participants can get assistance and information. Covered Health Plan participants will be sent new ID cards that meet the new requirement directly from Anthem Blue Cross in late December or early January.
Plans must create a process to verify the accuracy of their provider databases and update at least every 90 days. If a Plan participant is informed that a provider is a network provider when in fact he/she/they are a non-network provider, the Plan cannot impose the higher cost sharing that would apply to a non-network provider and must apply any paid amounts to the participant’s network deductible and out-of-pocket limits.
This requirement applies to all individual and group health plans, including the Health Plan, and shifts financial liability for inaccurate provider databases away from the consumer and back to the insurer. For the Health Plan, this will affect the Provider Finder, sponsored by Anthem Blue Cross and available at www.dgaplans.org/networkproviders under Medical Providers.
Plans must notify individuals who are “continuing care patients” of the right to continue to receive care after termination of a provider/facility contract.
“Continuing care patients” include patients who are undergoing a course of treatment for a serious or complex condition, undergoing institutional or inpatient care, scheduled to undergo non-elective surgery including post-operative care, pregnant and undergoing treatment, or terminally ill and receiving services.
Effective January 1, 2022, if you are a continuing care patient, the Health Plan will be required to notify you in a timely manner when Anthem Blue Cross terminates its contracts with the network provider or facility and inform you of your right to elect continued transitional care from the provider or facility. The Health Plan will also allow you ninety (90) days of continued coverage at network cost sharing to allow for a transition of care to a network provider.
You will be notified of further changes.
You will be notified of further changes on the Plans website and in subsequent Spotlight on Benefits newsletters. If you have questions regarding this information, please contact our Participant Services Department at (323) 866-2200, Ext. 401, Monday–Friday, 8:30 a.m.–5:00 p.m., Pacific Time.
