No Surprises Act: What Long Island Employers Must Know

Imagine your employee has a heart attack and gets rushed to the nearest emergency room. The hospital is out of network, but your employee had no choice in the matter. Before recent changes in federal law, that employee could have faced thousands in surprise medical bills. Today, thanks to the No Surprises Act, they're protected from most of those unexpected costs.

As a Long Island business owner, understanding this law helps you better explain your health benefits to employees and ensures your plan stays compliant with federal requirements.

What Is the No Surprises Act?

The No Surprises Act is a federal law that protects people from surprise medical bills in specific situations. Think of it as a shield that prevents healthcare providers from billing patients directly for certain out-of-network services when the patient had no reasonable way to choose an in-network provider instead.

The law doesn't eliminate all out-of-network costs, but it does protect employees in three key scenarios: emergency services, non-emergency services at in-network facilities where an out-of-network provider gets involved, and air ambulance services.

How the Protection Works

Here's how the No Surprises Act protects your employees step by step:

Emergency Situations: When an employee needs emergency care, they must be treated as if they went to an in-network provider, regardless of which hospital they end up at. They'll pay their normal in-network emergency room copay or deductible, and that's it.

Surprise Out-of-Network Providers: Sometimes an employee goes to an in-network hospital but gets treated by an out-of-network doctor (like an anesthesiologist or radiologist). Under this law, the employee pays only their normal in-network cost-sharing amount.

Provider Disputes: When disagreements arise about payment between insurance companies and providers, they go through an arbitration process instead of billing the patient directly.

Why This Matters for Your Business

This law strengthens your employee benefits package without costing you extra money. Your health insurance premiums don't increase because of No Surprises Act protections, but your employees get significantly better financial protection.

From a retention and recruiting standpoint, employees highly value protection from financial catastrophe. Medical debt is a leading cause of personal bankruptcy, so having robust protections makes your benefits package more attractive to current and potential employees.

The law also reduces the stress and distraction that comes when employees face surprise medical bills. Instead of spending work time fighting billing departments or worrying about unexpected debt, they can focus on recovery and getting back to productive work.

What Your Employees Need to Know

Your employees should understand they're protected in genuine emergency situations and when they receive care from out-of-network providers at in-network facilities. However, they still need to be smart healthcare consumers.

The protections don't apply when employees voluntarily choose out-of-network care for non-emergency situations. If someone decides to see an out-of-network specialist for convenience rather than necessity, they'll still face higher out-of-network costs.

Employees should also know they have the right to receive good faith estimates for scheduled services and can file complaints if they believe they've been improperly billed.

Key Implementation Considerations

Most of the No Surprises Act requirements fall on healthcare providers and insurance companies rather than employers. However, you should ensure your benefits communication materials accurately reflect these protections.

Review your employee handbook and benefits summaries to make sure they explain emergency coverage correctly. Many employees still don't understand they're protected from surprise bills in true emergencies, which means they might avoid necessary care due to cost fears.

Consider how you'll handle employee questions about medical bills. While the law provides strong protections, billing errors still happen, and employees may need guidance on when and how to dispute charges.

How Benton Oakfield Helps Long Island Employers

At Benton Oakfield, we help Long Island businesses navigate healthcare compliance requirements like the No Surprises Act. We ensure your employee benefits stay compliant with federal laws while maximizing the value employees receive from their coverage.

We also help you communicate these protections clearly to your team. Many employees don't realize the extent of their coverage, which means they're not getting full value from the benefits you provide. Our team explains complex healthcare rules in plain English so your employees can make informed decisions about their care.

Rather than trying to stay current on every healthcare law change yourself, you can rely on our expertise to keep your plans compliant and your employees informed.

Ready to ensure your employee benefits maximize protection and value? Contact our team to review your current coverage and communication strategy.

Compliance Note: Benefit plan rules and tax implications vary based on company size and location. This guide is for educational purposes only. Please contact your Benton Oakfield representative to discuss how this applies to your specific situation.

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