Everyone knows that unexpected medical bills can pile up after an accident or sudden illness. In these situations, consumers often do not have the opportunity to shop around or even fully understand the cost of the medical treatments. When you receive the medical bill, you may not even know if the correct amount was billed or if it was covered by insurance.
A surprise medical bill is an unexpected bill typically from an out-of-network health care provider. Most consumers do not know they were out-of-network until they receive the bill. If your health insurance does not cover the full amount billed for these services, you will be billed the difference, known as “balance billing”.
The No Surprises Act (NSA) protects you from surprise medical bills effective January 1, 2022. If you have group health plan or group or individual health insurance coverage, the NSA protects you from surprise medical bills from out-of-network healthcare providers without prior authorization. It also bans out-of-network cost sharing methods like coinsurance and copayments for all emergency services and some non-emergency services. Supplemental care charges from out-of-network providers, like radiology or anesthesiology, who work at an in-network facility is also banned under the No Surprises Act. Some health care providers must disclose balance billing protections by the Federal and State agencies and outline the details to file a consumer complaint.
If you do not have health insurance or plan to use it, you should get a “good faith” estimate of your care cost prior to receiving the care. The health care provider can only bill you within a reasonable difference to this estimate. If the bill is at least $400 over the “good faith” estimate, you can dispute the charges though the patient-provider dispute resolution process.
Those who receive insurance coverage from Medicare, Medicaid, Indian Health Services, Veterans Affairs Health Care, or TRICARE already receive protection against surprise medical billing.
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