You learned in my last post that providers can ask you to waive your balance billing and cost sharing protections under the No Surprises Act. To do so, however, facilities must meet specific requirements. Here’s what you need to know in order to make the best decision for you.
Facility Notice & Consent Requirements
In order to legally comply with the waiver requirements, facilities’ notice and consent form has to:
- Be in writing on a Health & Human Services (HHS) approved form
- Include the provider’s name and a good faith estimate of your out-of-pocket costs
- Clearly state you are not required to consent to out-of-network items or services
Multiple providers can be included on one notice. However, the following information must be included for each provider:
- Name
- The care you will receive from the provider
- A good faith estimate of each provider’s costs
- The option to waive your protection individually by provider; in other words, you can choose to waive protection for some, but not all, of the providers
How the No Surprises Act Voluntary Process Works
The key thing to remember is that waiving your rights to the No Surprises Act protection is voluntary. You don’t have to agree to an out-of-network provider – even if the facility follows all the notification rules. Here are seven things the facility must do to make sure your choice is voluntary:
- Give you the form by itself; it can’t be buried in a stack of other forms you’re asked to sign
- Give you the form at least 72 hours before you receive the service
- If the service is scheduled less than 72 hours away, you must be given the notice at least three hours before receiving the service
- Give you the form on paper or electronically
- Make sure you or your representative sign the form
- If you sign the form, it must include a date and time of signature
- Give you a copy of the signed form
While all of these things are important, the process isn’t really voluntary if you don’t understand the form. The HHS included some provisions to help ensure you know what you’re signing.
Understand What You’re Being Asked to Sign
The notice and consent form must be translated into the 15 most common languages in the facility’s geographic region. Forms are often confusing. You may not understand a form even when it’s written in a language you speak. If you don’t understand what you’re being asked to sign, ask someone to explain it to you. Keep asking for an explanation until you do understand.
If you don’t understand any of the 15 languages being offered, the facility must provide you with an interpreter before getting your written consent. It’s your right to have an interpreter. Don’t hesitate to ask for one. Keep asking for help and clarification until you truly understand what you are signing.
Saying No or Changing Your Mind
Remember, waiving your protection is entirely voluntary. You can say “no” by refusing to consent. But what happens then? The provider can cancel the service. But if that happens, you cannot be charged a cancellation fee.
Can you change your mind after you agreed to waive your protection? Yes, you can. But you need to do so before receiving the service and your decision must be in writing.
Exceptions to the No Surprises Act Notice & Consent
The notice and consent form cannot be used for all out-of-network items and services. A facility cannot ask you to waive your rights for out-of-network items and services that are:
- Used for emergency medicine, anesthesiology, pathology, radiology, and neonatology
- Provided by assist surgeons, hospitalists, and intensivists
- Used for diagnostic purposes, such as radiology and laboratory
- Provided by an out-of-network provider if no in-network provider can deliver the same item or service at the facility
Of course, this might not stop a facility from asking you to waive your rights in these situations. If they do and you are billed for these services, get a detailed bill from the facility. Then formally challenge the bill by advising the facility’s billing department that they are in violation of the No Surprises Act. If that doesn’t work, file an appeal with your insurance provider or the facility’s patient advocate department. If none of that works, file a complaint with your state’s insurance commissioner. A health care advocate can help you or challenge the bills for you.
The No Surprises Act will be new for everyone. We all make mistakes. But sometimes patients are intentionally misled. Your best first step is to know your rights. Then make sure the facility is complying with all of their regulations. Don’t be shy about challenging facilities that are not in compliance. Above all, remember the choice to waive your No Surprises Act protections is entirely your choice.