Everyone deserves affordable healthcare.
When you’re in an emergency situation, the last thing you should have to worry about is whether your provider is in-network. But the US healthcare system is notoriously difficult to navigate. Even when you’re getting routine procedures, it can be hard to understand what you’ll end up paying for medical services.
The No Surprises Act is changing this. The act is driven by a simple ethos: that no one should get hit with a surprise medical bill ever again.
We’re proud Fearless and our partner, CivicActions, are supporting the Centers for Medicare and Medicaid Services’ (CMS) implementation of this critical act.
What is the No Surprises Act?
The core objective of the No Surprises Act is to ensure patients understand the cost of medical services, so they don’t get surprise bills, no matter their situation.
There are already programs with protections against high medical bills. Programs like:
- Medicare,
- Medicaid,
- Indian Health Services,
- Veterans Affairs Health Care,
- TRICARE
But the No Surprises Act ensures that everyone else is equally protected.
Danielle Wales, Program Manager for Fearless’ Health & Sciences portfolio, says the act simplifies navigating in-network versus out-of-network expenses. She recalled a time she was out of town on business and got very sick.
“I didn’t want to go anywhere, because I had no clue if they provided in-network coverage,” she said. While Danielle did eventually seek care, she was scared to learn what her bill would be.
This can be especially nerve-wracking if you’re living on a limited income. In this situation, a surprise medical bill can be financially devastating. This is why the No Surprises Act will have an especially big effect on vulnerable patients.
“Elderly people and people with a limited income — people who often really can't afford to get hit by surprise bills — they'll be effected the most,” Danielle said. “And this is wonderful. It means that this act will help those people who can't always help themselves, given their circumstances.”
Outside of ensuring that patients no longer have to worry about unexpected medical bills, the act also includes several other key elements.
The first is that it requires providers to give uninsured patients a good-faith estimate of what their costs will be. The act also created two dispute resolution processes: one to determine out-of-network payment amounts and another to determine payment amounts for uninsured individuals. Finally, the act created an appeal process for patients.
Fearless’ work implementing the No Surprises Act.
On our Web Experience and Content Management Services (WECMS) contract with CMS, Fearless and our partner CivicActions were already supporting CMS.gov. So, when CMS received the mandate to implement the No Surprises Act, we were prepared.
We were tapped to build out an informational portal announcing what the No Surprises Act is and what patients and providers can expect from it.
To meet this aim, we spun up a new Scrum team that could focus on this critical build-out. Because of the urgent nature of this work, the team moved at a rapid pace. They worked with CMS leadership to identify requirements and rapidly build out mockups and wireframes that they could then iterate on.
Building a new user-friendly section of the CMS website.
Thanks to this approach, we built out a new section of the CMS website that’s dedicated to the No Surprises Act in under a month.
“The new section of the CMS website provides all the information that both the providers of services and the patients themselves will need,” Danielle said. “It gives them access to everything they need to know, and then also walks them through the processes related to disputing information or actually getting bills paid.”
The section’s user- and mobile-friendly content makes these complex processes easy to understand. It provides information on how the rules outlined in the No Surprises Act protect people from surprise payments.
The section’s content is split into three core categories:
- Policies and resources,
- Out-of-network payment disputes,
- Consumer information.
The new content also explains how patients have been removed from the payment dispute process. “One thing this does is get the patient out of the mix with payment disputes, ensuring that providers work directly with health insurance providers,” Danielle said. “These issues are so difficult to understand, so getting the patient out of this process provides a huge benefit.”
Want to see the outcome of our team’s work? Head over to cms.gov/nosurprises.
This announcement was published independently of the Centers for Medicare and Medicaid Services (CMS). This release does not constitute or imply an endorsement by CMS or the United States Government of the product, process, or service, or its producer or provider. The views and opinions expressed in any referenced document do not necessarily state or reflect those of CMS or the United States Government.