No Surprises Billing

Learn About No Surprises Billing

Are you concerned about getting a higher medical bill than you expected? That’s where No Surprises Billing comes in.

When you see your doctor or other health care provider, they may bill you out-of-pocket costs like a copayment, coinsurance or a deductible. If your provider isn’t in your health plan’s network, you may incur other costs or have to pay the entire bill, yourself.

“Out of network” means that providers or their companies haven’t signed a contract with your health plan. Out-of-network providers can bill you for the difference between what your plan pays and the full cost of the service. This is called balance billing, and this is more likely to cost more than in-network costs for the same service. In addition, balanced billing might not count toward your annual out-of-pocket limit.

Surprise billing is an unexpected balanced bill. You might get one when you can’t control who is involved in your care, like when you have an emergency or when you visit an in-network practice or hospital but are treated unexpectedly by an out-of network provider.

The No Surprises Act protects people covered by health plans from getting surprise medical bills. This includes emergency services, non-emergency services from out-of-network providers at in-network facilities, and services from out-of-network air ambulance service providers. It sets up an independent dispute resolution process for payment disputes between plans and providers. And it provides new dispute resolution opportunities for uninsured and self-pay individuals when they receive a medical bill that is substantially greater than the good faith estimate they got from their provider.

Starting in 2022, there are new protections that prevent surprise medical bills. If you have private health insurance, these new protections ban the most common types of surprise bills. If you’re uninsured or you decide not to use your health insurance for a service, under these protections, you can often get a good faith estimate of the cost of your care up front, before your visit. If you disagree with your bill, you may be able to dispute the charges.

Download Patient Rights and Protections Against Surprise Billing