From the Desk of Allison Johnson - CAA- Surprise Billing Notifications
(Posted on 01/05/22)
I am sure by now you’re all sick of seeing CAA on emails you get from me. It feels like this is all we’ve been talking about for almost a year now. Well, the good news is that this new development is actually really cool, and will be great for our groups and customers!
As you know, NJ has been covered by a surprise billing rule for a few years now, so you may be wondering why this is news. NJ’s law, although it made significant improvements to the out-of-network billing experience, is not nearly as comprehensive as the CAA rule. Under this new rule, members across the country benefit from protection from huge bills they couldn’t possibly have anticipated. The three main things the CAA strives to address in this particular rule are emergency services, services provided at an in-network facility by an out-of-network provider, and air ambulance services. Still to come are the really cool parts of the CAA- reverse EOBs and more transparency into contracted rates.
So what does this mean for us right now? Group health plans and plan sponsors are required to provide a disclosure notice for plan or policy years beginning on or after January 1, 2022. This disclosure notice should be given to any individual who is a participant, beneficiary, or enrollee of a group health plan and it should be posted on the company website (if applicable). The DOL has provided a model notice and guidance on how to fill it out (links below). All in all, the notification piece is not a big deal, but this will make a big impact on the out of pocket costs of members across the country.
As you know, NJ has been covered by a surprise billing rule for a few years now, so you may be wondering why this is news. NJ’s law, although it made significant improvements to the out-of-network billing experience, is not nearly as comprehensive as the CAA rule. Under this new rule, members across the country benefit from protection from huge bills they couldn’t possibly have anticipated. The three main things the CAA strives to address in this particular rule are emergency services, services provided at an in-network facility by an out-of-network provider, and air ambulance services. Still to come are the really cool parts of the CAA- reverse EOBs and more transparency into contracted rates.
So what does this mean for us right now? Group health plans and plan sponsors are required to provide a disclosure notice for plan or policy years beginning on or after January 1, 2022. This disclosure notice should be given to any individual who is a participant, beneficiary, or enrollee of a group health plan and it should be posted on the company website (if applicable). The DOL has provided a model notice and guidance on how to fill it out (links below). All in all, the notification piece is not a big deal, but this will make a big impact on the out of pocket costs of members across the country.