The No Surprises Act is meant to keep patients from receiving surprise medical bills. Medical interpreters make sure LEP patients access those protections.
The federal No Surprises Act (NSA), which went into effect on January 1, 2022, is a major shift in US healthcare policy. Crafted as consumer protection in healthcare, the act protects patients from receiving surprise medical bills that result from gaps in health insurance networks—including emergency care and certain services provided by out-of-network clinicians at in-network medical facilities. As health systems adjust to comply with this act, medical interpretation will play a crucial role in expanding protections.
Although medical billing can be confusing for anyone, this is especially true for patients with limited English proficiency (LEP). Compounding the risk of surprise medical bills is the fact that LEP patients are more likely to seek emergency care, regardless of insurance coverage or injury. The higher rate of contact with emergency rooms (which usually have more complex billing) means medical interpreters will play a vital role in ensuring everyone is protected under the NSA.
What Are Surprise Medical Bills?
Surprise medical bills arise when insured patients receive care from out-of-network hospitals, doctors, or other health care providers that they didn’t choose. This occurs in about 1 in 5 emergency room visits, and between 9% and 16% of in-network hospitalizations for non-emergency care.
Unfortunately, bills from out-of-network providers (such as anesthesiologists) at in-network facilities can quickly add up. When health plans deny these out-of-network claims or apply higher out-of-network sharing costs, patients are left shouldering the financial burden. Many patients in the past have not been warned in advance about these costs or given the option to change their treatment day, time or location to get an in-network provider.
What Is the No Surprises Act?
The No Surprises Act promises to protect patients from receiving surprise medical bills by:
- Requiring private health plans to cover out-of-network claims and apply in-network sharing costs.
- Prohibiting doctors, hospitals, and other covered providers from billing patients more than in-network sharing costs.
According to federal estimates, the act will apply to roughly 10 million out-of-network surprise medical bills a year.
How Medical Interpreters Can Help LEP Patients
Under the NSA, providers and health plans must identify bills that are protected and notify patients about their rights. Yet as errors inevitably occur, patients may need to either appeal a decision or file a complaint. When a patient has limited English skills, either during the notification or appeals process, a medical interpreter will need to step in to help.
Medical interpreters can assist when LEP patients:
- Have questions about medical bills for either the care team or the insurer.
- Need to appeal health plan denials.
- Contact the “applicable enforcement agency” when a provider bills incorrectly.
- Contact the national consumer complaint system.
- Contact their state Consumer Assistance Program (CAP).
What Health Care Providers and Insurers Can Do
From the descriptions above, we can see medical interpreters will play an important role in helping LEP patients navigate the new legislation. To ensure patients have access to an interpreter—regardless of language, healthcare providers can consider using a remote interpretation platform such as Boostlingo.
In providing this language support at the time of notification, providers will ensure compliance with the NSA and make sure LEP patients fully understand the care they are receiving.