When you’re in the middle of a medical emergency, you don’t usually have time to shop around for healthcare services. If you’re in an ambulance, you might not know whether they are taking you to an in-network hospital for emergency care. Only later, after it’s all over, do you end up with surprise bills from out-of-network providers.
The good news is that the No-Surprises Act went into effect in 2022. This piece of legislation provides protection from surprise medical bills, especially in emergencies. Here’s what you need to know about the No Surprises Act.
What is the No Surprises Act?
Many people aren’t aware of the No Surprises Act, which went into effect on January 1, 2022. This act is designed to help patients avoid surprise medical bills during emergency care.
A surprise medical bill is one that comes after you receive care. You might not realize that the company operating the air or ground ambulance services that took you to safety was out-of-network for you. Maybe you were at an in-network hospital, but the anesthesiologist was an out-of-network provider. Or perhaps your health insurance doesn’t cover the lab that processed your test results.
Later, after you’re back to regular life, you receive a bill for the services your insurance company didn’t cover. This practice is called balance billing. You’re charged for the cost of out-of-network services your insurance wouldn’t cover.
The No Surprises Act reduces the balance companies can bill you after they’ve received payments from insurance. It’s meant to protect you from this practice during emergencies when you cannot compare healthcare options or might not be able to choose where to go or what services to get.
How the No Surprises Act Protects You
The No Surprises Act bans certain practices that normally result in surprise medical bills. Some of the prohibited practices for those who have health insurance include:
- Surprise medical bills resulting from emergency care received from an out-of-network provider.
- Cost sharing for out-of-network emergency services. This means you don’t have to pay out-of-network copays and coinsurance for emergency services rendered, and even covers some non-emergency services.
- Creating balance bills and out-of-network charges for providers that offer supplemental care at an in-network facility. So, if a radiologist or anesthesiologist is out-of-network but providing services at an in-network hospital, they can’t charge you the out-of-network rate.
For those without health insurance, the No Surprises Act also offers protection. The provider must give you a good-faith estimate of how much the care will likely cost before they begin. In the event the care you receive costs at least $400 more than the good faith estimate, you can dispute the charges.
How to Waive Your No Surprises Act Protection
It’s possible to waive your protection after you are in stable condition and no longer need emergency care. If you’re in an out-of-network facility or have access to out-of-network providers, they might ask you to sign a notice and consent form. This notice and consent is a way for you to acknowledge that you understand you’re about to get out-of-network services and agree to pay for them.
You might also need to waive your protection if you knowingly schedule a procedure or some other service with an out-of-network facility. If you don’t sign the form, you might be discharged as soon as you no longer need emergency care. Or you might not be able to schedule a procedure.
Your knowledge that you’re getting out-of-network care beyond emergency services means that this is no longer a surprise bill.
How to Dispute a Surprise Medical Bill
If your health insurance company isn’t covering the cost, and you get a surprise medical bill for these services, the No Surprises Act offers recourse.
First, your health plan documents should have information about how to dispute a charge on them. For emergency care, you should only have to pay your in-network cost-sharing requirements (copays or coinsurance), regardless of whether the facility or providers are out-of-network. Follow the dispute process outlined in your documents.
If you think you’re still being treated unfairly under the No Surprises Act, you can submit a complaint through the Centers for Medicare & Medicaid Services.
Uninsured patients will receive a good faith estimate related to their care when they schedule a service. You can also request a good-faith estimate later. The federal government has a dispute resolution process that you can use to help settle the issue. This process is also accessible through the Centers for Medicare & Medicaid Services. You must initiate the resolution process within 120 days of receiving a bill that amounts to $400 more than the good faith estimate.
A No Surprises Help Desk is available 8 a.m. to 8 p.m. Eastern every day. You can call 800-985-3059 with your questions about submitting complaints and disputes and help navigating your protections under the No Surprises Act.
Billing in our healthcare system can feel frustrating at times, especially when you’re in an emergency. The No Surprises Act helps alleviate some of the concerns over medical billing and provides some protection from surprise costs.
This article is intended for general informational and educational purposes only, and should not be construed as financial or tax advice. For more information about whether a reverse mortgage may be right for you, you should consult an independent financial advisor. For tax advice, please consult a tax professional.
