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Patient Rights Regarding Surprise Medical Bills

What is the No Surprise Act?

The No Surprise Act was established to protect patients who receive health insurance coverage through their employer (including a federal, state, or local government,) through the Health Insurance Marketplace®, or directly through an individual health plan from being balanced billed for services when they are treated by a non-contracted provider or facility in the scenarios defined below:

  • Prohibit surprise billing for emergency services. Emergency services, even if they’re provided out-of-network, must be covered at an in-network rate without requiring prior authorization.
  • Prohibit balance billing and out-of-network cost-sharing (like out-of-network co-insurance or copayments) for emergency and certain non-emergency services. In these situations, the patient’s cost for the service cannot be higher than if these services were provided by an in-network provider, and any coinsurance or deductible must be based on in-network provider rates.
  • Prohibits out-of-network charges and balance billing for ancillary care by out-of-network physicians at an in-network facility.
  • Prohibits certain other out-of-network charges and balance billing without advance notice.
  • Before health care providers and facilities can bill the patient, they must provide the patient with a plain-language notice explaining that patient consent is required to get care on an out-of-network basis, ask for consent, and provide a good faith estimate in the allotted timeframe.
  • For patients who do not have insurance (uninsured or self-pay), these rules make sure the patient knows how much their health care will cost before they get it, and might help them if they get a bill that is larger than expected by allowing them to file a dispute when the actual cost is greater than $400.00 from the estimate.
  • The rules do not apply to patients with coverage through programs like Medicare, Medicaid, Indian Health Services, Veterans Affairs Health Care, or TRICARE because these programs have other protections which do not allow balance billing.

We know this new rule may create a lot of questions and/or concerns. We are here to help as you navigate the billing process. Please contact our facility financial counselor with any questions.

To read the disclosure in its entirety, please click on the link below: