No Surprise Act

Your Rights and Protections Against Surprise Medical Bills

Effective January 1, 2022, the No Surprises Act was implemented to protect patients from unexpected medical bills when receiving emergency care or treatment from out-of-network providers at in-network facilities. This law ensures you are only responsible for the in-network cost-sharing amount (like co-pays, co-insurance, and deductibles) under these circumstances.

What Is Balance Billing?

When you see a doctor or receive services at a facility that isn’t in your health plan’s network, you may be billed for the difference between what your insurance covers and what the provider charges. This is known as balance billing or a surprise medical bill.

The No Surprises Act prohibits balance billing in many common scenarios, including:

• Emergency services, even if provided at an out-of-network facility.
• Non-emergency services by out-of-network providers at in-network hospitals or ambulatory surgical centers.

Unless you give written consent, you can’t be charged more than your plan’s in-network rates for these services.

Your Protections Include:

• You are only required to pay your share of the cost (like deductibles, copayments, and coinsurance) that you would pay if the provider or facility were in-network.
• Out-of-network providers can’t surprise you with higher bills for emergency or certain non-emergency services.
• You are not required to sign any documents waiving these protections for certain services.
• You have the right to receive a Good Faith Estimate of the total expected cost of any non-emergency medical items or services if you’re uninsured or choosing not to use your insurance.

Good Faith Estimate for Uninsured or Self-Pay Patients

If you don’t have insurance or are not using your insurance, you have the right to receive a written estimate of the cost of care before you receive a service. This estimate should include all expected charges for services and items.

You can request a Good Faith Estimate at any time before your appointment.

Learn More

For more information about your rights under the No Surprises Act, visit the official CMS website:

https://www.cms.gov/nosurprises

If you have any questions or concerns, please contact our office for assistance.