Medical bill Every surprise balance bill is a balance bill, but not every balance bill is a surprise balance bill. (Photo: Shutterstock)

Editor’s note: Over the next three days, The PHIA Group’s Ron E. Peck is going to take us on a deep and thorough dive into the nuances of thiis much-heralded piece of health care reform. Hang on tight!

As a member of the health benefits community, I, like many of you, have heard about the No Surprises Act (NSA). Many representatives of our health insurance and benefits community have reached out to me asking whether this “new law” will make balance billing “illegal,” and thus enable plans to leave their networks behind and pay claims solely based upon a Reference Based Pricing (“RBP”) methodology. Others have asked whether it sets a mandatory pricing methodology or sets rates for Out of Network (“OON”) claims, thereby eliminating RBP as a way of pricing OON claims.

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