Surprise medical bills can have a significant financial impact on patients who thought their insurance plan covered their medical services. This can happen when patients receive out-of-network services, emergency care, or unintentional referrals to out-of-network providers. To combat this problem, the US Congress passed the No Surprises Act in December 2020, which outlines new rules for insurance companies and healthcare providers to reduce surprise medical bills. One key provision of the Act is the Good Faith Estimate (GFE) requirement, which obliges healthcare providers to give patients an estimate of their expected medical costs at least three days before their appointment or procedure.
A recent study published in the Journal of the American Medical Association (JAMA) evaluated the impact of the GFE requirement on surprise billing. The study analyzed 18,005 emergency department visits from the first quarter of 2019 to the first quarter of 2021 at two hospitals in California that had implemented GFE requirements six months before the No Surprises Act was signed into law. The study found that the proportion of visits resulting in a surprise bill decreased from 7.1% to 2.7%, and the average surprise bills decreased from $1,758 to $253. The study suggests that GFE requirements can effectively reduce surprise billing and decrease the financial burden on patients.
The GFE provision of the No Surprises Act requires healthcare providers to give patients an estimate of the expected costs of their medical services. This estimate must be provided to the patient at least three days before the scheduled appointment or procedure and must include information on the total cost of the medical service, the patient’s financial responsibility, the healthcare provider’s network status, and how the patient can obtain data about their insurance benefits. The GFE requirement aims to give patients more information about their healthcare costs and help them make informed decisions about their health care.
The GFE requirement has several potential benefits, including increased transparency, improved patient satisfaction, and reduced administrative burden. To overcome the challenges of implementing the GFE requirement, healthcare providers can adopt technology solutions that automate the GFE process, develop a clear pricing strategy, improve data management, and provide training and education to staff members responsible for providing GFEs to patients.
Under the No Surprises Act, healthcare providers must provide patients with a good faith estimate of the cost of certain medical procedures, including both in-network and out-of-network services. To comply with these new requirements, healthcare providers are working closely with clients to ensure that they have the necessary information to provide accurate estimates to patients. The No Surprises Act also includes provisions to protect patients from unexpected bills, including requiring patients to pay their in-network cost-sharing amounts for out-of-network services.
In conclusion, the GFE requirement of the No Surprises Act is an important step towards reducing surprise medical bills and improving transparency in healthcare costs. Although it presents challenges, the GFE requirement has the potential to increase patient satisfaction, reduce administrative burden, and improve healthcare outcomes. Healthcare providers should work closely with their patients and insurance companies to ensure they can provide accurate GFEs and comply with the No Surprises Act.
