Newsroom

  • No Surprises Act Notice

    No Surprises Act NoticeJanuary 01, 2022

    Your Rights and Protections Against Surprise Medical Bills
    When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.

    What is "balance billing" (sometimes called "surprise billing")?
    When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in the Fund’s PPO networks.

    “Out-of-network” describes providers and facilities that haven’t signed a contract with the Fund’s PPO networks. Out-of-network providers may be permitted to bill you for the difference between what is covered under the Plan (i.e., what the Plan will pay) and the full amount charged for a service. This is called "balance billing." This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.

    “Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.

    You are protected from balance billing for:

    Emergency services
    If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is the Plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can't be balance billed for these emergency services. This includes services you may get after you’re in stable condition unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

    Certain services at an in-network hospital or ambulatory surgical center

    When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is the Plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can't balance bill you and may not ask you to give up your protections not to be balance billed. If you get other services at these in-network facilities, out-of-network providers can't balance bill you, unless you give written consent and give up your protections.

    You're never required to give up your protections from balance billing. You also aren't required to get care out-of-network. You can choose a provider or facility in your plan's network.

    When balance billing isn't allowed, you also have the following protections:
    1. You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). The Plan will pay out-of-network providers and facilities directly.
    2. The Plan generally must:
      - Cover emergency services without requiring you to get approval for services in advance (prior authorization).
      - Cover emergency services by out-of-network providers.
      - Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits (EOB).
      - Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

    If you believe you've been wrongly billed, you may contact the Department of Labor at (800) 985-3059. You may also contact the Fund’s Administrative Office at (800) 932-4790. Visit https://www.cms.gov/nosurprises/consumers for more information about your rights under federal law.

  • In-person visits

    In-person visitsMay 03, 2022

    NWA is open to assist plan participants in our offices. To assure the best customer experience for an in-person visit, we encourage you to schedule an appointment by visiting the Contact Us page. We value your time, so appointments are not required but will greatly assist in our ability to assist you without unreasonable delay. If you prefer to meet by telephone or video conference, give us a call and we will schedule a time if we cannot offer immediate assistance.

  • Machine Readable Files

    Machine Readable FilesFeb 21, 2023

    The Transparency in Coverage final rule requires group health plans to make available to the public two separate machine-readable files that include detailed pricing information. The first file shows negotiated rates for all covered items and services between the plan or issuer and in-network providers. The second file consists of the historical payments to, and billed charges from, out-of- network providers. Plans must publicly display these data files in a standardized format and provide monthly updates. To access the applicable URL, please search the web for Machine Readable Files followed by the name of the health and welfare Trust Fund you are looking for.