Wiki No Surprises Act - Loss of Insurance During Treatment

[RMedlock001]

Regarding the No Surprise Act, and more specifically providing a Good Faith Estimate to self insured patients, we are struggling finding literature anywhere on CMS regarding a certain scenario. Here is the situation - I have identified a case where the patient originally started treating as an insured patient, and the insurance was verified as active at the time of service. Fast forward to several weeks later the patient has now transitioned to a self pay patient in the midst of treatment after discovering insurance has now lapsed. Does anyone have any helpful links or information that you have found related to this specific scenario when treatment has already been rendered and we are now encountering insurance denials? This seems like a gray area. Thanks in advance!

 

[csperoni]

My understanding of NSA is that you must provide it to known self pay patients, or patients with insurance who ask for it.
If at the time of services already provided, the patient stated they had insurance, AND the insurance was verified, then I don't see how NSA would apply to services already provided.
If the patient is receiving ongoing care, and you now know they are self pay, then estimates should be provided within the required timeframe of scheduled appointments.