The No Surprises Act is a federal law enacted to protect patients from unexpected medical bills incurred on or after January 1, 2022. It aims to address the issue of surprise medical billing, which can occur when patients receive unexpected charges for their medical care. The Act applies to out-of-network emergency services, out-of-network air ambulance services, and specific out-of-network care received at in-network facilities.
Help for Seniors
The Act is important for all patients, but especially for seniors. Seniors are especially vulnerable to surprise medical billing because they often need more health care than others. They are more likely to be seen by out-of-network providers. The Act protects them from unexpected charges and provides a much-needed safeguard for their medical expenses.
Under the Act, patients are not responsible for surprise medical bills beyond their in-network cost-sharing amount. This means that patients will only be responsible for paying the same amount they would have paid if an in-network provider provided the care. The Act also prohibits balance billing, when providers bill patients for the difference between their charges and the amount paid by the patient’s insurance.
This can be relevant in seniors’ settings, including emergency room visits, second opinions, surgical procedures, and even skilled nursing care, where independent contractors provide services. Under the Act, providers must accept the Medicare-approved amount as payment in full. This prevents patients from being surprised with large balances and protects them from unexpected financial hardship.
Exceptions to the Act
Some providers and services are exempt from the Act’s billing protections (although your state may have a similar law that does not exempt them). These include:
- Ground ambulance services, which can charge you out-of-network rates
- Vision-only and dental-only insurances, which are not subject to balance billing protections
- Indemnity plans such as hospital indemnity insurance, which are exempt from the Act
If You Are Uninsured
The No Surprises Act provides rules for a good faith estimate of how much a medical service will cost for uninsured or self-paying patients. You may request an estimate if you schedule a medical service at least three business days out or ask for one. If your final bill is $400 or more than the estimate, you may be able to dispute it. Having a good faith estimate allows patients to make informed decisions about their care.
Independent Dispute Resolution
The Act establishes an independent dispute resolution (IDR) process to resolve payment disputes between providers and insurers. This process allows providers and insurers to submit their proposed payment amounts to an independent arbiter who makes the final decision. The IDR process protects patients from being caught in payment disputes and ensures a fair resolution for all parties involved.
Pricing Transparency
In addition to protecting patients from surprise medical bills, the Act includes provisions to increase healthcare pricing transparency. Health insurers must provide patients with clear and detailed information about their healthcare coverage. This consists of describing providers’ network status and estimated cost-sharing amounts. This increased transparency empowers patients to make informed healthcare decisions and avoid unexpected charges.
The No Surprises Act is a significant step toward addressing surprise medical billing and protecting patients from financial harm. By implementing clear rules and procedures, patients are not caught off guard by unexpected charges and have access to fair dispute resolution. With the Act in place, patients can have more confidence in seeking medical care, knowing they will not face unexpected financial burdens.
This article is for informational purposes only and shall not be construed as legal advice. No attorney-client relationship between the reader and Brennan & Rogers, PLLC, or its attorneys is intended. This article should not be used as a substitute for legal advice. Laws may vary from state to state, and the educational materials found in this article may not apply in all jurisdictions. Brennan & Rogers, PLLC | 279 York Street, York, ME 03909 | 207-361-4680 | admin@brennanrogers.com
