Control No Suprises Act Risk, Before It Controls Your Plan

Surprise medical bills still occur because the NSA doesn’t apply to every situation, and providers don’t always comply with the law.

Common reasons surprise bills still happen include:

• Services not covered under NSA (e.g., non-emergency out-of-network care at out-of-network facilities)
• Post-stabilization care billed out-of-network
• Incorrect or misleading notice-and-consent forms
• Billing errors or misclassified provider status
• Providers attempting unlawful balance billing
• Air ambulance charges exceeding allowable limit (*plan exclusions)

Why it matters:

Even when members are protected, employers may still face arbitration-driven cost increases if disputes are not actively managed.

Plans and members must still verify accuracy, prevent overcharges, and ensure NSA compliance, because unlawful bills still get sent.

The NSA impacts both employee experience and plan administration.

For employees:

• They may still receive confusing or inaccurate bills that appear to be balance bills
• They often struggle to understand what they legally owe under NSA protections
• Unexpected bills can cause stress and lower satisfaction

For the health plan:

• Incorrect NSA handling can lead to higher claims costs
• Providers may initiate payment disputes or IDR cases
• There’s risk of regulatory issues if the plan mishandles NSA-covered claims
• Administrative burden increases without clear processes

Why it matters:

A strong NSA compliance and defense strategy protects both employees’ financial wellbeing and the plan’s cost control and risk management goals.

aequum helps identify, challenge, and resolve bills that may violate the NSA or your plan’s pricing structure.

Our support includes:

• Reviewing the claim for NSA applicability
• Identifying balance billing violations
• Contacting the provider directly to dispute improper charges
• Pursuing cost reductions or complete removal of unlawful amounts
• Assisting with or managing IDR when required

Why it matters:

Members are protected from paying charges they don’t legally owe, and the plan avoids unnecessary or inflated payments.

Yes. Reference-based pricing (RBP) can work to avoid the NSA, but it requires careful coordination.

How RBP interacts with NSA protections:

• RBP uses benchmarks like Medicare-based pricing, offering predictable and defensible costs
• Eliminates or limits applicability of the IDR Process
• Helps keep costs to plan participants in check
• Greater transparency in the billing process

Why it matters:

Combining RBP with solid NSA compliance improves pricing predictability and strengthens the plan’s cost-control strategy, while avoiding unnecessary provider disputes.

You should involve aequum as early as possible, ideally when you receive an Open Negotiation Notice.

Contact us when:

• You receive an Open Negotiation Notice or a Notice of Offer deadline is set.
• A member receives a bill for emergency services, out-of-network care at an in-network facility, or an air ambulance
• A provider attempts balance billing on an NSA-eligible claim

Why it matters:

Early review prevents escalation, strengthens defense, and ensures both the member and the plan are fully protected under NSA rules and cost-containment strategies.