In July, HHS released an “interim final rule” (IFC) relating to the No Surprises Act. This IFC protects individuals from surprise medical bills for emergency services, air ambulance services provided by out-of-network providers, and non-emergency services provided by out-of-network providers at in-network facilities in certain circumstances. If a plan or coverage provides or covers any benefits for emergency services, this FIC require emergency services to be covered:
a. Without any prior authorization
b. Regardless of whether the provider is an in-network provider or an in-network emergency facility
c. Regardless of any other term or condition of the plan or coverage other than the exclusion or coordination of benefits, or a permitted affiliation or waiting period.
Emergency services include certain services in an emergency department of a hospital or an independent freestanding emergency department, as well as post-stabilization services in certain instances. This IFC also limits cost sharing for out-of-network services subject to these protections to no higher than in-network levels, requires such cost sharing to count toward any in-network deductibles and out-of-pocket maximums, and prohibits balance billing. These limitations apply to out-of-network emergency services, air ambulance services furnished by out of network providers, and certain non-emergency services furnished by out of network providers at certain in-network facilities, including hospitals and ambulatory surgical centers.
