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    • Federal No Surprises Act information for providers

    Find information about Federal No Surprise bills and the provider negotiation and independent dispute resolution process.

    How does the Federal No Surprises Act protect consumers?

    How does the Federal No Surprises Act protect consumers?

    When a member receives emergency care — or is treated by an out-of-network provider at an in-network hospital, ambulatory surgical center or by an air ambulance provider — they are protected from balance billing (meaning, a surprise bill for the amount over the amount the plan paid).

     

    The Federal No Surprises Act (NSA) requires the member’s cost share to be based on the Qualifying Payment Amount (the QPA) — otherwise known as the Median in-network rate. Providers cannot bill the member for more than their cost share.

    How to open a negotiation

    Under the NSA, if you don’t accept the QPA and want to initiate an Open Negotiation, you have 30 business days from when you received the initial claim payment or denial.  

     

    Steps to open a negotiation:

    How to initiate Independent Dispute Resolution

    If we don’t reach an agreement by the end of the Open Negotiation, you may initiate the Federal Independent Dispute Resolution (IDR) process for eligible claims within four business days of the end of the Open Negotiation period. You can find the form to start this process below.

     

    Steps to initiate IDR:

    Legal notices

    Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company and its affiliates (Aetna).

    This material is for information only. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Information is believed to be accurate as of the production date; however, it is subject to change.

    Health benefits and health insurance plans contain exclusions and limitations.