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No Surprises Act Overview:
- Why: The legislation aims to prevent consumers becoming saddled with unexpected medical costs.
- Who: The bipartisan No Surprises Act took effect on Jan. 1, 2022.
- Where: The No Surprises Act affects individuals nationwide.
The newly enacted No Surprises Act aims to protect privately insured individuals from receiving unexpected medical bills after getting health care services. Uninsured individuals must also now receive more advanced information of their costs from a health care provider. The protections cover most emergency care and many instances of non-emergency care.
A recent report from the US Department of Health & Human Services (HHS) Office of the Assistant Secretary for Planning and Evaluation (ASPE) found that about one in five privately insured patients who go to the emergency room, have an elective surgery or give birth in a hospital receive surprise medical bills.
Now unable to bill individuals for services rendered, medical providers are “still fighting with regulators over how they will be paid” in the event of out-of-network care, according to the New York Times.
While out-of-network air ambulance providers are included in this new legislation, ground ambulances can still bill you directly for their services.
No Surprises Act Protections for Insured Individuals
The prevention of surprise bills covers individuals who have health coverage through an employer, a Health Insurance Marketplace® or an individual health plan purchased directly from an insurer.
Under the act, insured individuals who receive in-network emergency care won’t pay more than the already agreed-upon cost-sharing rates. This means you will still be responsible for copays and deductibles.
Sometimes you may receive care from out-of-network providers even if you visit an in-network hospital. In these cases, cost-sharing for certain additional services will be based on in-network rates.
The No Surprises Act also requires health care providers and facilities to share with patients easily understood notices of applicable billing protections. Patients must also be notified of the proper contacts in case they are concerned about a potential violation of these new protections.
No Surprises Act Protections for Uninsured Individuals
There are fewer concrete protections for those who do not have health insurance or pay for care on their own. The No Surprises Act merely requires most providers to give a “good faith estimate” of costs before providing non-emergency care.
This estimate must include expected charges for the primary item or service and any additional items or services that would be reasonably expected. The HHS uses the example of someone getting surgery who must receive the estimated cost of the surgery as well as any labs, tests and anesthesia that might be used during the procedure.
If you receive a final bill that exceeds the providers’ “good faith estimate” by $400 or more, you can dispute that final cost.
No Surprises Act Help Desk
Anyone, whether insured or uninsured, can contact the No Surprises Help Desk at 1-800-985-3059 from 8 a.m.-8 p.m. ET seven days a week, TTY: 800-985-3059, with further questions or concerns about a violation of these rights and billing disputes. More information can also be found at CMS.gov/nosurprises where you can also register potential violations of the No Surprises Act.
Learn more about a Surprise Medical Bill Class Action Lawsuit Investigation (links to paid attorney advertising).
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4 thoughts onBipartisan No Surprises Act to Protect Insured From Unexpected Medical Costs
dd me
Add me have some that went to collections
Add me. I got a surprise ambulance bill from a collector/Atty for a ride that was 3 yrs old. I was transferred from one hospital to another due to a lack of beds.
add me please this has happened to me a lot