News Details

ADA addresses No Surprises Act questions

The ADA has received questions from member dentists regarding the No Surprises Act, and whether this bill could potentially affect dental practices. The following appeared in the ADA News:

To help clear up confusion on the new law, the ADA has created the following Q&A. This resource is based on what the ADA knows as of Dec. 9. If the ADA learns additional information, it will be shared with dentists as soon as possible.

Question: What is the No Surprises Act?

Answer: In December 2020, the Consolidated Appropriations Act of 2021 was enacted. The law contains many provisions to help protect consumers from surprise bills, including the No Surprises Act. Starting Jan. 1, consumers will have new billing protections when getting emergency care, non-emergency care from out-of-network providers at in-network facilities and air ambulance services from out-of-network providers. Through new rules aimed to protect consumers, excessive out-of-pocket costs will be restricted, and emergency services must continue to be covered without any prior authorization, regardless of whether a provider or facility is in-network.
Q: Are dentists subject to the No Surprises Act?

A: For the most part, no, because dental benefits are considered “excepted benefits” under the new law. The surprise billing rule applies to group health claims and health insurance issuers.

The ADA has heard about infrequent cases where the surprise billing dispute resolution provisions could apply. For example, embedded dental benefits working with a medical plan could be subject to the rule but the treatment would need to be done in an out-of-network hospital or ambulatory center under a plan with no out-of-network reimbursement. This is rare and can be solved on an ad hoc basis by plans.

Q: What health care facilities are included under the No Surprises Act?

A: According to the law, hospitals, ambulatory surgical centers, rural health centers and federally qualified health centers are all examples of health care facilities that are included in the No Surprises Act. Private dental practices are not included in this definition.

Q: How does the No Surprises Act relate to Open Payments?

A: It doesn’t. The U.S. Centers for Medicare & Medicaid Services’ Open Payments is a national disclosure program that promotes a more transparent and accountable health care system. Open Payments houses a publicly accessible database of payments that reporting entities, including certain drug and medical device companies and group purchasing organizations, make to covered recipients like physicians. Open Payments does apply to dentists, but this does not mean that surprise billing applies to dentists. They are separate rules.