Majority of Health Insurers Concerned Over No Surprises Act’s Impending Transparency Requirements

Survey highlights level of compliance preparedness and increasing skepticism towards new regulations.

A recent poll of more than 100 healthcare execs revealed a majority of insurers are concerned about the No Surprises Act (NSA) Transparency requirements.

The findings are a result of a survey conducted in July 2021 by Zelis, which polled healthcare insurers to assess their current readiness and preparation plans to meet the requirements set by the No Surprises Act (NSA).

The NSA seeks to protect patients from surprise medical bills and includes transparency requirements, including an Advanced Explanation of Benefits (AEOB) for members that applies to both in- and out-of-network care. The way the law is currently written, for any healthcare service, a provider must send the patient’s insurer an estimate of expected charges. With that information, the insurer creates an AEOB, including the patient’s out-of-pocket estimates, and sends it to the patient before the scheduled service.

Results from the survey indicate:

  • Three-quarters of respondents (74%) are concerned about meeting the Advanced Explanation of Benefits (AEOB) requirements.
  • Nearly two-thirds (63%) don’t know how they’re going to obtain the provider estimates required for AEOBs.
  • More than half (58%) expressed uncertainty about their ability to obtain the additional data required for AEOBs.

The company first polled insurers in January about the healthcare system’s ability to achieve compliance with the NSA by the January 1, 2022 deadline.

This NSA survey is the second conducted. The first survey in the beginning of the year was about the healthcare system's ability to achieve compliance with the NSA by January of 2022. In this latest survey, an overwhelming majority of insurers’ current NSA concerns stem from the AEOB requirements.

Chief Legislative Affairs Officer of Zelis, Matthew Albright, said the AEOB requirements are going to be a heavy lift for many insurers, considering 73% rely on paper-based processes for payments and more than half aren’t sure how to get the necessary pricing data,.

"Any insurer still using paper-based billing and member communication should make a plan now to digitize and streamline those processes and make them more efficient, data-driven and faster," Albright said. "Those with outdated systems will struggle to comply with the NSA and will likely experience greater challenges, higher costs, and more administrative work than before.”

CEO of Zelis, Amanda Eisel said the NSA is a call-to-action for the healthcare industry to better serve and support health plan members.

"Now more than ever, insurers and providers must collaborate to successfully navigate the complexity of the law,” Eisel said. “Innovative solutions that can be seamlessly integrated are critical.”