What is the No Surprises Act and how does it affect my practice?

The No Surprises Act limits balance-billing for certain out-of-network and emergency care and requires good-faith estimates for uninsured and self-pay patients. For most independent practices, the practical impact is the good-faith-estimate workflow plus the out-of-network dispute (IDR) process for the situations it covers.

What actually matters

• Uninsured and self-pay patients must get a good-faith estimate of expected charges
• Surprise balance-billing is restricted for certain out-of-network and emergency situations
• An Independent Dispute Resolution (IDR) process exists for OON payment disputes
• There are provider disclosure requirements about balance-billing rights
• For most practices the real lift is the good-faith-estimate process

Common questions

Where Volari fits: For out-of-network underpayments, the Act's IDR process is one more lever to challenge a claim that paid below fair value.

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