Knowledge Center

Written by Robert Tennant, Vice President Federal Affairs

As we now know, the No Surprises Act (included in H.R. 133) requires that uninsured, self-pay, and commercially insured patients be given a “good faith estimate” (GFE) of the cost for their medical service. When a service requires the involvement of multiple providers or facilities, such as surgery, a “convening provider or facility” is responsible for contacting all other potential providers or facilities that may be involved in the patient’s service (“co-providers”), requesting a GFE for their portion of the service, compiling the GFEs, and giving them to the patient if the patient is uninsured or self-pay.

With there being currently no standardized data exchange process for the convening provider/facility requirement WEDI conducted a survey to ascertain how difficult this convening provider/facility requirement will be to implement. We received 274 responses. Small providers/clinics made up 39.6% of respondents, 11.5% of respondents were from large provider clinics, 10.4% were from health systems, 8.5% from medium sized clinics, 2.2% from hospitals, the remainder are from other provider types or other entities.

Highlights from the WEDI survey include:

• Almost 2/3rds (65.8%) of respondents said it would be difficult or very difficult to determine who should be the convening provider/facility.

 

• The vast majority (89.1%) stated it would be difficult or very difficult for the convening provider/facility to identify all appropriate co-providers and/or facilities for the specific medical service.

 

• More than 9 out of 10 (91.5%) said it would be difficult or very difficult for the convening provider/facility to collect GFEs from” co-providers and/or facilities for the specific medical service.

 

• Almost 9 out of ten (89%) stated it would be difficult or very difficult to provide the patient the completed GFEs within the required 3 business days of being requested or the service being scheduled.

 

• Most importantly, more than 8 out of ten respondents (83.1%) were somewhat or stronglysupportive for the government delaying the requirement for the convening provider/facility to obtain a GFE from any co-provider/facility until there is standardized data exchange process in place to communicate information between convening providers and co-providers/co-facilities.

The survey results suggest strongly that providers and facilities will face significant challenges just identifying who the convenor should be, who the appropriate co-providers/facilities should be, and how to collect GFEs from these co-providers/facilities. As well, respondents were adamant that meeting the legislation’s 3-day deadline to get the GFE to the patient would be difficult or very difficult. Not surprising, respondents expressed strong support for the government delaying the convenor requirement until a standardized process to exchange data between convening providers and co-providers/co-facilities is established.

Access the full survey results here and additional WEDI No Surprises Act comment letters and resources at the WEDI No Surprises Act Resource Center.