Healthcare Uncovered Episode 3: Damned If You Do, Damned If You Don’t: The "No Surprises Act”

Dr. Eric Bricker
Dr. Eric Bricker
April 5, 2023

Do you know what the No Surprises Act does to doctors? I can tell you...the answer will surprise you.  I’m revealing the answers in this week’s episode of Healthcare Uncovered.

In the third episode of Healthcare Uncovered I break down The No Surprises Act, which went into effect on January 1st, 2022, and what it means for doctors.  

What is The No Surprises Act?  

This act forbids a doctor who refused to accept low insurance company reimbursement from billing a patient directly if the doctor saw the patient at a hospital that did accept the insurance reimbursement. So if a doctor chooses to be out-of-network because they think insurance reimbursement is too low, then the doctor can’t bill the patient if they practice at a hospital that IS in-network with the insurance company. The act requires the out-of-network doctor and the insurance company to enter into arbitration over payment.  

But there’s a catch!  

The Federal Government created a ‘benchmark’ price that is to be used in the arbitration as guidance. That’s called the Qualifying Payment Amount (QPA). Turns out the QPA is the same thing as the insurance company discounted payment amount...the same thing it pay in-network doctors. The same thing that the out-of-network doctor refused to accept in the first place.  

So the No Surprises Act essentially forces doctors that refused to take the insurance company’s discounted rate to then take the discounted rate as payment in full. And that’s where you’re damned if you do, damned if you don’t.  

Doctors, there are solutions. We break it all down in Episode 3 of Healthcare Uncovered.  

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