Understanding the No Surprises Act

Navigating medical bills can be confusing and stressful. Unexpected charges from out-of-network providers can leave you with hefty bills you didn’t plan for. Fortunately, the no surprise billing law is designed to protect patients from these unexpected costs. In this post, I’ll walk you through what this law means, how it works, and what you can do to avoid surprise medical bills.

What Is the No Surprise Billing Law?

The no surprise billing law is a federal regulation aimed at protecting patients from unexpected medical bills. These surprise bills often happen when you receive care from a provider or facility that is not in your insurance network, without your knowledge. This law ensures that you only pay your in-network cost-sharing amounts for emergency services and certain non-emergency services provided by out-of-network providers at in-network facilities.

Here’s what the law covers:

• Emergency services, regardless of where they are provided.

• Non-emergency services from out-of-network providers at in-network hospitals or ambulatory surgical centers.

• Air ambulance services from out-of-network providers.

  
  

The goal is to eliminate surprise bills and make healthcare costs more predictable. This law also sets up a process for providers and insurers to resolve payment disputes without involving the patient.

Hospital emergency room entrance

Emergency rooms are a common place where surprise billing can occur.

How the No Surprise Billing Law Protects You

Before this law, many patients received bills for thousands of dollars after an emergency or surgery, even when they thought they were using in-network providers. The no surprise billing law changes that by:

• Limiting your out-of-pocket costs to what you would pay for in-network care.

• Prohibiting balance billing, which is when providers bill you for the difference between their charge and what your insurance pays.

• Requiring clear communication about your network status and costs before non-emergency care.

• Providing a dispute resolution process between providers and insurers to settle payment disagreements.

  
  

For example, if you go to an in-network hospital for surgery, but the anesthesiologist is out-of-network, you won’t be stuck with a surprise bill. Instead, you pay your usual in-network copay or coinsurance, and the provider and insurer work out the rest.

Medical bills and calculator on desk

Understanding your medical bills can help you avoid surprise charges.

What Are Examples of Surprise Medical Bills?

Surprise medical bills can happen in many situations. Here are some common examples:

1. Emergency Room Visits

   You visit the ER for a sudden illness or injury. Even if the hospital is in-network, some doctors like radiologists or emergency physicians might be out-of-network and bill you separately.

   
   

2. Surgery at an In-Network Facility

   You schedule surgery at an in-network hospital. However, some specialists involved in your care, such as anesthesiologists or pathologists, may be out-of-network and send you surprise bills.

   
   

3. Ambulance Services

   You need an ambulance ride to the hospital. If the ambulance company is out-of-network, you could receive a large bill, even if the hospital is in-network.

   
   

4. Diagnostic Tests

   You get an MRI or CT scan at an in-network facility, but the radiologist reading the images is out-of-network.

   
   

These examples show how surprise bills can come from providers you didn’t even know were involved in your care.

Ambulance parked outside hospital

Ambulance rides are a common source of surprise medical bills.

How to Protect Yourself from Surprise Medical Bills

While the no surprise billing law offers strong protections, there are steps you can take to avoid surprise bills altogether:

• Check your provider network before receiving care. Use your insurance company’s website or call customer service to confirm if providers are in-network.

• Ask questions upfront. If you need a procedure, ask if all providers involved are in-network.

• Request an estimate. For planned care, ask for a cost estimate and whether any out-of-network providers will be involved.

• Know your rights. If you receive a surprise bill, you can dispute it through the process set up by the law.

• Use in-network facilities and providers whenever possible.

  
  

If you ever get a surprise bill, don’t ignore it. Contact your insurance company and the provider to understand the charges and start the dispute process if needed.

What to Do If You Receive a Surprise Medical Bill

If you receive a bill that seems unexpected or unusually high, here’s what you should do:

1. Review the bill carefully. Check the dates, services, and providers listed.

2. Compare with your insurance explanation of benefits (EOB). Make sure the charges match what your insurer processed.

3. Contact your insurance company. Ask if the provider is in-network and if the charges are correct.

4. Reach out to the provider’s billing office. Sometimes billing errors happen, and they can correct them.

5. File a dispute if necessary. The no surprise billing law provides a formal process to resolve payment disagreements without involving you.

   
   

Remember, you should only be responsible for your in-network cost-sharing amounts for covered services protected by the law.

The no surprises act is a significant step forward in protecting patients from unexpected medical costs. By understanding how this law works and taking proactive steps, you can avoid surprise bills and focus on your health without financial stress. Stay informed, ask questions, and don’t hesitate to advocate for yourself when it comes to medical billing.