{"id":23869,"date":"2023-03-02T14:14:52","date_gmt":"2023-03-02T20:14:52","guid":{"rendered":"https:\/\/www.aae.org\/specialty\/?p=23869"},"modified":"2023-03-02T14:15:23","modified_gmt":"2023-03-02T20:15:23","slug":"clarification-on-the-no-surprises-act","status":"publish","type":"post","link":"https:\/\/www.aae.org\/specialty\/clarification-on-the-no-surprises-act\/","title":{"rendered":"Clarification on the No Surprises Act"},"content":{"rendered":"

By Catherine <\/span>French, AED\u202ffor\u202fAdvocacy\u202fand\u202fProfessional\u202fRelations<\/span>\u00a0<\/span><\/p>\n

The No Surprises Act went into effect Jan. 1, 2022. The law gives consumers billing protections when getting emergency care, nonemergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers.\u00a0 Since its inception, there have been questions about how the law impacts dentists.\u00a0\u00a0<\/span>\u00a0<\/span><\/p>\n

In late February, CMS clarified that dental providers and facilities are \u201cgenerally required to provide uninsured patients with a good faith estimate of expected charges\u201d unless the patient is enrolled in an excepted benefit plan or coverage such as a stand-alone dental plan, according to the Centers for Medicare & Medicaid.<\/span>\u00a0<\/span><\/p>\n

\u202fThe agency did note that providers and facilities are \u201cgenerally not required to provide a good faith estimate to an individual enrolled in an excepted benefit plan or coverage such as a limited-scope dental plan, even if the individual is not enrolled in other coverage.\u201d<\/span>\u00a0<\/span><\/p>\n

The CMS also said there were two exceptions to the good faith estimate rule:<\/span><\/p>\n

\u201cIf the excepted benefit plan or coverage does not cover a scheduled or requested item or service (for example, because the excepted benefit plan is a limited-scope vision plan and the individual is scheduling dental services), and the individual has no other coverage for the item or service, that individual is considered uninsured with respect to that item or service, and the provider or facility must give them an uninsured or self-pay good faith estimate,\u201d the response said. \u201cSimilarly, if the individual does not seek to have a claim for the item or service submitted to their excepted benefit plan or coverage, and the individual has no other coverage for that item or service, that individual is considered self-pay with respect to that item or service, and the provider or facility must give them an uninsured (or self-pay) good faith estimate.<\/span><\/p>\n

\u201cIn both of these cases, the individual with the uninsured or self-pay good faith estimate would be eligible to initiate the Patient-Provider Dispute Resolution process if the provider or facility\u2019s bill is at least $400 more than the estimate in the good faith estimate.\u201d<\/span>
\n\u202f<\/span>
\nCMS also noted that in making the determination as to whether the individual is uninsured or self-pay, \u201cthere is no requirement in [the regulation] that providers or facilities verify coverage for each item or service with the individual\u2019s plan or issuer. Providers and facilities may make this determination based on its inquiries of the individual under [the regulation.]\u201d<\/span>\u00a0<\/span><\/p>\n

AAE members should immediately review office policy to ensure estimates are provided to uninsured and self-pay patients.\u00a0<\/span>\u00a0<\/span><\/p>\n

For information on all of the Centers for Medicare & Medicaid guidance on the No Surprises Act, visit\u202f<\/span>CMS.gov\/NoSurprises<\/span><\/a>.<\/span>\u00a0<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

By Catherine French, AED\u202ffor\u202fAdvocacy\u202fand\u202fProfessional\u202fRelations\u00a0 The No Surprises Act went into effect Jan. 1, 2022. The law gives consumers billing protections when getting emergency care, nonemergency care from out-of-network providers at…<\/p>\n","protected":false},"author":45,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"content-type":"","_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[210],"tags":[],"feature":[200],"class_list":["post-23869","post","type-post","status-publish","format-standard","hentry","category-advocacy","feature-news"],"yoast_head":"\nClarification on the No Surprises Act - American Association of Endodontists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.aae.org\/specialty\/clarification-on-the-no-surprises-act\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Clarification on the No Surprises Act - American Association of Endodontists\" \/>\n<meta property=\"og:description\" content=\"By Catherine French, AED\u202ffor\u202fAdvocacy\u202fand\u202fProfessional\u202fRelations\u00a0 The No Surprises Act went into effect Jan. 1, 2022. The law gives consumers billing protections when getting emergency care, nonemergency care from out-of-network providers at…\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.aae.org\/specialty\/clarification-on-the-no-surprises-act\/\" \/>\n<meta property=\"og:site_name\" content=\"American Association of Endodontists\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/endodontists\" \/>\n<meta property=\"article:published_time\" content=\"2023-03-02T20:14:52+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-03-02T20:15:23+00:00\" \/>\n<meta name=\"author\" content=\"Curtis Ksenak\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@savingyourteeth\" \/>\n<meta name=\"twitter:site\" content=\"@savingyourteeth\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Curtis Ksenak\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\/\/www.aae.org\/specialty\/clarification-on-the-no-surprises-act\/#article\",\"isPartOf\":{\"@id\":\"https:\/\/www.aae.org\/specialty\/clarification-on-the-no-surprises-act\/\"},\"author\":{\"name\":\"Curtis Ksenak\",\"@id\":\"https:\/\/www.aae.org\/specialty\/#\/schema\/person\/0186bae7d8db10549ed288f65f362991\"},\"headline\":\"Clarification on the No Surprises Act\",\"datePublished\":\"2023-03-02T20:14:52+00:00\",\"dateModified\":\"2023-03-02T20:15:23+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\/\/www.aae.org\/specialty\/clarification-on-the-no-surprises-act\/\"},\"wordCount\":453,\"publisher\":{\"@id\":\"https:\/\/www.aae.org\/specialty\/#organization\"},\"articleSection\":[\"Advocacy\"],\"inLanguage\":\"en-US\"},{\"@type\":\"WebPage\",\"@id\":\"https:\/\/www.aae.org\/specialty\/clarification-on-the-no-surprises-act\/\",\"url\":\"https:\/\/www.aae.org\/specialty\/clarification-on-the-no-surprises-act\/\",\"name\":\"Clarification on the No Surprises Act - American Association of Endodontists\",\"isPartOf\":{\"@id\":\"https:\/\/www.aae.org\/specialty\/#website\"},\"datePublished\":\"2023-03-02T20:14:52+00:00\",\"dateModified\":\"2023-03-02T20:15:23+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/www.aae.org\/specialty\/clarification-on-the-no-surprises-act\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/www.aae.org\/specialty\/clarification-on-the-no-surprises-act\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/www.aae.org\/specialty\/clarification-on-the-no-surprises-act\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/www.aae.org\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Specialty\",\"item\":\"https:\/\/www.aae.org\/specialty\/\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Clarification on the No Surprises Act\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/www.aae.org\/specialty\/#website\",\"url\":\"https:\/\/www.aae.org\/specialty\/\",\"name\":\"American Association of Endodontists\",\"description\":\"Shaping the Future of Endodontic\",\"publisher\":{\"@id\":\"https:\/\/www.aae.org\/specialty\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/www.aae.org\/specialty\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\/\/www.aae.org\/specialty\/#organization\",\"name\":\"American Association of Endodontists\",\"url\":\"https:\/\/www.aae.org\/specialty\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/www.aae.org\/specialty\/#\/schema\/logo\/image\/\",\"url\":\"https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2017\/04\/aae_share_specialty.jpg\",\"contentUrl\":\"https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2017\/04\/aae_share_specialty.jpg\",\"width\":1200,\"height\":628,\"caption\":\"American Association of Endodontists\"},\"image\":{\"@id\":\"https:\/\/www.aae.org\/specialty\/#\/schema\/logo\/image\/\"},\"sameAs\":[\"https:\/\/www.facebook.com\/endodontists\",\"https:\/\/x.com\/savingyourteeth\",\"https:\/\/www.linkedin.com\/company\/american-association-of-endodontists\",\"http:\/\/www.youtube.com\/rootcanalspecialists\"]},{\"@type\":\"Person\",\"@id\":\"https:\/\/www.aae.org\/specialty\/#\/schema\/person\/0186bae7d8db10549ed288f65f362991\",\"name\":\"Curtis Ksenak\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/www.aae.org\/specialty\/#\/schema\/person\/image\/\",\"url\":\"https:\/\/secure.gravatar.com\/avatar\/adf0ca75af9a97066abbe955c004d7050041f3746a5976994b3652ed9597253b?s=96&d=mm&r=g\",\"contentUrl\":\"https:\/\/secure.gravatar.com\/avatar\/adf0ca75af9a97066abbe955c004d7050041f3746a5976994b3652ed9597253b?s=96&d=mm&r=g\",\"caption\":\"Curtis Ksenak\"}}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Clarification on the No Surprises Act - American Association of Endodontists","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/www.aae.org\/specialty\/clarification-on-the-no-surprises-act\/","og_locale":"en_US","og_type":"article","og_title":"Clarification on the No Surprises Act - American Association of Endodontists","og_description":"By Catherine French, AED\u202ffor\u202fAdvocacy\u202fand\u202fProfessional\u202fRelations\u00a0 The No Surprises Act went into effect Jan. 1, 2022. The law gives consumers billing protections when getting emergency care, nonemergency care from out-of-network providers at…","og_url":"https:\/\/www.aae.org\/specialty\/clarification-on-the-no-surprises-act\/","og_site_name":"American Association of Endodontists","article_publisher":"https:\/\/www.facebook.com\/endodontists","article_published_time":"2023-03-02T20:14:52+00:00","article_modified_time":"2023-03-02T20:15:23+00:00","author":"Curtis Ksenak","twitter_card":"summary_large_image","twitter_creator":"@savingyourteeth","twitter_site":"@savingyourteeth","twitter_misc":{"Written by":"Curtis Ksenak","Est. reading time":"2 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/www.aae.org\/specialty\/clarification-on-the-no-surprises-act\/#article","isPartOf":{"@id":"https:\/\/www.aae.org\/specialty\/clarification-on-the-no-surprises-act\/"},"author":{"name":"Curtis Ksenak","@id":"https:\/\/www.aae.org\/specialty\/#\/schema\/person\/0186bae7d8db10549ed288f65f362991"},"headline":"Clarification on the No Surprises Act","datePublished":"2023-03-02T20:14:52+00:00","dateModified":"2023-03-02T20:15:23+00:00","mainEntityOfPage":{"@id":"https:\/\/www.aae.org\/specialty\/clarification-on-the-no-surprises-act\/"},"wordCount":453,"publisher":{"@id":"https:\/\/www.aae.org\/specialty\/#organization"},"articleSection":["Advocacy"],"inLanguage":"en-US"},{"@type":"WebPage","@id":"https:\/\/www.aae.org\/specialty\/clarification-on-the-no-surprises-act\/","url":"https:\/\/www.aae.org\/specialty\/clarification-on-the-no-surprises-act\/","name":"Clarification on the No Surprises Act - American Association of Endodontists","isPartOf":{"@id":"https:\/\/www.aae.org\/specialty\/#website"},"datePublished":"2023-03-02T20:14:52+00:00","dateModified":"2023-03-02T20:15:23+00:00","breadcrumb":{"@id":"https:\/\/www.aae.org\/specialty\/clarification-on-the-no-surprises-act\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/www.aae.org\/specialty\/clarification-on-the-no-surprises-act\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/www.aae.org\/specialty\/clarification-on-the-no-surprises-act\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/www.aae.org\/"},{"@type":"ListItem","position":2,"name":"Specialty","item":"https:\/\/www.aae.org\/specialty\/"},{"@type":"ListItem","position":3,"name":"Clarification on the No Surprises Act"}]},{"@type":"WebSite","@id":"https:\/\/www.aae.org\/specialty\/#website","url":"https:\/\/www.aae.org\/specialty\/","name":"American Association of Endodontists","description":"Shaping the Future of Endodontic","publisher":{"@id":"https:\/\/www.aae.org\/specialty\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/www.aae.org\/specialty\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/www.aae.org\/specialty\/#organization","name":"American Association of Endodontists","url":"https:\/\/www.aae.org\/specialty\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/www.aae.org\/specialty\/#\/schema\/logo\/image\/","url":"https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2017\/04\/aae_share_specialty.jpg","contentUrl":"https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2017\/04\/aae_share_specialty.jpg","width":1200,"height":628,"caption":"American Association of Endodontists"},"image":{"@id":"https:\/\/www.aae.org\/specialty\/#\/schema\/logo\/image\/"},"sameAs":["https:\/\/www.facebook.com\/endodontists","https:\/\/x.com\/savingyourteeth","https:\/\/www.linkedin.com\/company\/american-association-of-endodontists","http:\/\/www.youtube.com\/rootcanalspecialists"]},{"@type":"Person","@id":"https:\/\/www.aae.org\/specialty\/#\/schema\/person\/0186bae7d8db10549ed288f65f362991","name":"Curtis Ksenak","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/www.aae.org\/specialty\/#\/schema\/person\/image\/","url":"https:\/\/secure.gravatar.com\/avatar\/adf0ca75af9a97066abbe955c004d7050041f3746a5976994b3652ed9597253b?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/adf0ca75af9a97066abbe955c004d7050041f3746a5976994b3652ed9597253b?s=96&d=mm&r=g","caption":"Curtis Ksenak"}}]}},"acf":[],"_links":{"self":[{"href":"https:\/\/www.aae.org\/specialty\/wp-json\/wp\/v2\/posts\/23869","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.aae.org\/specialty\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.aae.org\/specialty\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.aae.org\/specialty\/wp-json\/wp\/v2\/users\/45"}],"replies":[{"embeddable":true,"href":"https:\/\/www.aae.org\/specialty\/wp-json\/wp\/v2\/comments?post=23869"}],"version-history":[{"count":0,"href":"https:\/\/www.aae.org\/specialty\/wp-json\/wp\/v2\/posts\/23869\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.aae.org\/specialty\/wp-json\/wp\/v2\/media?parent=23869"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.aae.org\/specialty\/wp-json\/wp\/v2\/categories?post=23869"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.aae.org\/specialty\/wp-json\/wp\/v2\/tags?post=23869"},{"taxonomy":"feature","embeddable":true,"href":"https:\/\/www.aae.org\/specialty\/wp-json\/wp\/v2\/feature?post=23869"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}