Home | 8/4/2022 Issue | Article

Directory glitch caused patient overcharge? Under NSA, you pay, not the plan

Effective Aug 4, 2022
Published Aug 8, 2022
Last Reviewed Aug 4, 2022
Question: I know the No Surprises Act (NSA) and the CMS rules that put it in practice require that provider directories be kept up to date. But I thought that was all the insurers’ responsibility. The other day I was looking at guidance from a CMS’ Center for Consumer Information & Insurance Oversight (CCIIO) that says, among other things, “Under the No Surprises Act, providers and health care facilities must generally ... refund enrollees amounts paid in excess of in-network cost-sharing amounts with interest, if the enrollee has inadvertently received out-of-network care due to inaccurate provider directory information.” Why is this the providers’ responsibility?

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