Balance Billing and Other No Surprises Act Rules

Review this practice note from Practical Guidance – Healthcare to understand the principal provisions of the No Surprises Act, including balance billing and reimbursement rate rules for group health plans and health insurance issuers. Learn how, for certain services, these rules prohibit surprise billing of participants, constrain participant cost-sharing obligations, and establish a mandatory negotiation and arbitration process to resolve reimbursement rate disputes between the plan or issuer and the service provider. Advise clients regarding important provisions that impose continuity of care at in-network rates for certain patients and provide for a right to external review of adverse determinations.

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