Understanding the No Surprises Act

Surprise medical bills can turn a doctor’s visit or emergency room visit into a financial headache. That’s why the No Surprises Act, which went into effect on January 1, 2022, was created. This federal law is designed to protect you from unexpected out-of-network medical bills, especially in situations where you have little or no control over who provides your care.

The No Surprises Act aims to stop surprise billing for:

• Emergency services received at an out-of-network facility

• Non-emergency services at in-network hospitals where out-of-network providers are involved (such as a radiologist or anesthesiologist)

• Air ambulance services from out-of-network providers

This bill is meant to protect you if you go to an in-network hospital or have an emergency and get treated by someone who isn’t in your network. This bill helps protect you from being billed more than the in-network cost-sharing amount.

Before this law, people could end up with unexpected medical bills costing them thousands of dollars, simply because they didn’t know a provider was out-of-network. The No Surprises Act puts the responsibility on health plans and providers to sort out payments.

Thanks to the No Surprises Act:

• When receiving scheduled, non-emergent, or post stabilization care, you will be given a Notice and Consent form that can ask you  to waive your protections where other nearby in-network care is available.

• You’ll receive a good faith estimate of expected charges before receiving care if you’re uninsured or self-paying.

• You have the right to dispute a bill if the final charges are much higher than the estimate.

The law does not apply to:

• Ground ambulance services (still a common source of surprise bills).

• Services where you knowingly and voluntarily use an out-of-network provider.

It is always a good idea to know what nearby hospitals are in-network for your plan. However, understanding your rights under the No Surprises Act can save you stress and money if you find yourself in an emergency at an out-of-network facility.