What is a “surprise medical bill” and what should I know about the No Surprises Act?
A surprise medical bill is an unexpected bill from an out-of-network provider or at an out-of-network facility. Effective January 1, 2022, the No Surprises Act may protect you from surprise medical bills under certain circumstances.
Medical debts often occur after an accident or sudden illness. Consumers are rarely informed of the costs of medical treatment in advance and may have little or no ability to “shop around.” When you get a medical bill, you may not know if you actually received the billed treatment, if the correct amount was billed, if the amount is covered by insurance, and if the amount was already paid or partially paid.
What is a Surprise Medical Bill?
A surprise medical bill is an unexpected bill, often for services received from a health care provider or facility that you did not know was out-of-network until you were billed. Your health insurance may not cover the entire out-of-network cost which leaves you owing the difference between the billed cost and the amount your health insurance paid. This is known as “balance billing.” This bill could be for a service like anesthesiology or laboratory tests. You may not know that the provider or facility is out-of-network until you are billed.
How does the No Surprises Act protect me?
Effective January 1, 2022, the No Surprises Act (NSA) protects you from surprise billing if you have a group health plan or group or individual health insurance coverage, and bans:
Surprise bills for emergency services from an out-of-network provider or facility and without prior authorization
Out-of-network cost-sharing, like out-of-network coinsurance or copayments, for all emergency and some non-emergency services
Out-of-network charges and balance bills for supplemental care, like radiology or anesthesiology, by out-of-network providers that work at an in-network facility