Spotlight Mandate: Balance billing consent and new disclosure added to EOB

The regulation includes an exception where an out-of-network provider can balance bill a member for a non-emergency service if the provider follows a specific notice process and receives the member’s prior consent to be balance billed. The notice and consent process is available for use by an out-of-network provider or out-of-network emergency facility when furnishing certain post-stabilization services, or an out-of-network provider when furnishing non-emergency services (other than ancillary services) at an in-network facility. In addition, a new disclosure will appear on all explanations of benefits (EOBs) explaining No Surprises Act balance billing protections and federal agency contact information if the member believes there has been a violation.

Who it applies to: Fully insured group health plans, self-funded group health plans and individual policies – including all grandfathered plans.

Effective date: Plan years beginning on or after Jan. 1, 2022

Action required: No member or employer group action is needed at this time; changes will be made within BCBSND systems.