Help is Here: Protecting Consumers from Unexpected Medical Bills through the No Surprises Help Desk

Case Story

Context

Certain Medical Services Can Lead to Unexpectedly High Medical Bills

In 2020, Congress passed the No Surprises Act (NSA) to provide federal protections against surprise medical bills for consumers. Previously, consumers in the private healthcare market could be subject to higher healthcare costs for out-of-network care, known as balance billing. These balance bills often occur when consumers seek emergency care and can cost thousands of dollars.

The law protects consumers by restricting excessive out-of-pocket costs and ensures emergency services are covered without prior authorization regardless of whether the provider or facility is in-network. To address billing and payment discrepancies, the NSA established a process by which healthcare providers and insurance companies may establish mutually agreeable payment amounts for services and scenarios that commonly result in balance billing.

The Challenge

Implementing Consumer Protections Required an Aggressive Timeline

The NSA required the Centers for Medicare & Medicaid Services (CMS) to establish a way for consumers, providers, and issuers to report suspected violations of the law. This process – now called the No Surprises Help Desk – had to be designed and implemented in less than one year so consumers and other entities could immediately understand the protections available to them.
5 second response time to consumer phone inquiries
144K people received answers about their surprise medical bills
109K consumer complaints filed against law violators

Our Innovative Solution

Customer Experience (CX) and Healthcare Expertise Empowered a Seamless Implementation

Cognosante helped CMS implement and staff a multi-tiered contact center (help desk) to manage all calls and web-based submissions related to NSA complaints and violations. Leveraging our CX expertise, we:

  • Completed all hiring, training and implementation tasks to ensure that trained customer service representatives (CSRs) were prepared to handle calls on the first day of operation,
  • Implemented a process for contacting consumers about complaints that required additional information before they could be forwarded to the appropriate government agency for investigation,
  • Informed development of a user-friendly web page and online complaint form to guide consumers through the process of filing complaints, and
  • Worked with CMS to assume responsibility for accurately triaging complaints that fall under the authority of states or territories, significantly reducing administrative burden on CMS staff.

Our Tangible Results

Consumers are Supported and Protected with Exceptional Service

  • More than 144,000 people have received answers to their inquiries about surprise medical bills, and 109,000 filed complaints against potential violators.
  • Phone inquiries are consistently answered in under 5 seconds, providing prompt service to callers in stressful situations.
  • 90% of web-based inquiries are directed to the appropriate entity the same day.

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