VUMC prepared to comply with No Surprises ActDec. 16, 2021, 9:36 AM
by Paul Govern
Effective Jan. 1, Vanderbilt University Medical Center will deliver treatment cost estimates to all patients who do not provide insurance information when scheduling services three or more days in advance.
The move is in direct response to the No Surprises Act, which was signed into federal law Dec. 27, 2020. The law is designed to protect patients from surprise medical bills and remove consumers from payment disputes between their provider or health care facility and their health plan. Major provisions of the law take effect Jan. 1, 2022.
The changes apply at all VUMC locations that deliver care — the main campus, Vanderbilt Wilson County Hospital, Vanderbilt Tullahoma-Harton Hospital, Vanderbilt Bedford County Hospital and related outpatient facilities.
Under the law, consumers who do not have insurance or do not provide insurance information must receive upfront cost estimates directly from their health care providers and facilities. Providers and facilities must also provide these estimates to any insured patients who request them. Other provisions of the law, which will go into effect at a later date, concern upfront cost information provided by insurance companies to health plan members.
To ensure compliance with the law, VUMC is enhancing processes for gathering patient insurance information during the scheduling process, said Heather Dunn, vice president, Revenue Cycle Services.
“VUMC remains committed to giving its patients the highest level of care regardless of their ability to pay,” Dunn said. “Initially, patients and families without identified coverage who come to us for elective services may be surprised to see their estimated costs spelled out like this ahead of time. As always, our customer service representatives stand ready to assist patients and families in applying for community and government-sponsored programs.”
Patients can visit the Vanderbilt Health website for Department of Finance contact information and information on financial assistance eligibility. The website also provides a cost estimator tool that allows prospective patients, whether insured or uninsured, to estimate their costs for many common procedures and services.
In the law’s other provisions, emergency services, even if provided out of network, must be covered by insurers at in-network rates. The law also bans out-of-network charges by out-of-network providers providing services at an in-network facility. VUMC is adopting additional safeguards to ensure that patients with commercial out-of-network coverage are not charged more than the applicable in-network rate for these services.
“The scheduling and estimate delivery measures, in particular, will most directly affect our Patient Access Services call centers, patient services specialists and other call center staff who interact with patients,” Dunn said. “Beyond that, all patient-facing employees should be aware of these changes so they can engage patient questions and feedback about the changes they’re experiencing.”
The communication plan includes website updates, signage in emergency care and hospital admitting areas, and patient communications to accompany the treatment cost estimates sent to patients without identified insurance coverage. Staff who schedule and register patients will be receiving communication reinforcing the need to identify insurance coverage during scheduling, and the need to make updates in eStar that reflect the patient’s insurance coverage.
VUMC employees seeking more information about these changes should contact their manager.