Maintaining your health can be costly, and an unexpected medical bill can lead to significant financial stress. Understanding your costs before services are rendered can shield you from surprises and help you prepare for potential financial hardship.
The No Surprises Act was enacted on January 1, 2022, and protects patients from these surprise medical bills in several ways. It restricts excessive out-of-pocket costs and ensures that emergency services are covered without prior authorization, regardless of whether or not a provider or facility is in-network.
And it benefits more than just insured people. If you do not have health insurance, there are protections under the act to protect you from unplanned costs, too.
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Key Protections Under the No Surprises Act
There are several protections for the consumer provided under the No Surprises Act, including the following:
- Bans surprise bills for emergency services: When you visit an emergency room or receive emergency medical care, there will be no out-of-network pricing or surprise billing.
- Bans out-of-network cost-sharing: Some insurance plans offer a network of providers for you to choose from. If you visit an out-of-network provider, your insurance may pay less towards the cost, leaving a larger portion for you to pay. However, this act bans medical providers from charging the customer a higher percentage of the cost for services, especially emergency services, obtained out-of-network.
- Bans out-of-network charges for certain additional services: If a patient visits an in-network provider and that provider uses out-of-network providers for additional services, such as lab testing or anesthesia, the patient will not be billed the out-of-network cost for these additional services.
- Requires that healthcare providers explain your applicable protections: Before billing, the healthcare provider must give the patient a notice explaining their billing protections and who to contact with concerns. Patients can waive their rights under the act but must fully understand the situation and give written consent.
- Requires an estimate to be given to those who are uninsured: If you do not have medical insurance, the medical provider must give you a good-faith estimate. This refers to an estimate that is close to the cost that the provider can reasonably calculate.
The Benefits of the No Surprises Act
Costly medical bills can bring major stress to your life. The No Surprise Act aims to eliminate the stress and hardship of surprise bills. The act has many benefits, including the following:
- Protection from unexpected and exorbitant medical bills: Knowing your medical bills before you receive services can allow you to better prepare for the costs.
- Elimination of surprise balance billing: Balance billing refers to the portion of the bill that the patient will receive after the health insurance plan pays their amount on an out-of-network bill. By eliminating these bills for emergency services and some nonemergency services, there are no unexpected bills if you need emergency care.
- Improved transparency in healthcare costs: Healthcare bills can be costly and confusing. The No Surprises Act established a uniform billing procedure nationwide. This allows more transparency in healthcare costs.
- Enhanced cost predictability for consumers: With no surprise bills, consumers can better prepare for their medical costs. Also, if they are provided with a contact for billing concerns, they are better prepared if they need to file a complaint or concern.
- The right to dispute and appeal medical bills: If you receive an unexpected out-of-network medical bill or the bill is much more than your good-faith estimate, you have the right to dispute and appeal it.
How to Dispute a Surprise Medical Bill
Although the No Surprises Act aims to eliminate surprise medical bills, it is still possible that you can receive one. If you do, you can dispute and appeal that bill. You will need to follow the following steps to do so:
- Ensure that the bill violates the No Surprises Act. Not all unexpected medical bills will be covered by the act. For example, bills arising from ambulance rides are not covered.
- Contact the medical provider’s billing department and ask for an itemized bill. This bill will have a breakdown of all the services provided and a billing code.
- File a dispute. You can file a dispute by following the patient-provider dispute resolution. This resolution is provided by a third party that will review your dispute and determine the appropriate action. You can file a dispute online at CMS.gov or by mail. You may need to provide copies of your medical bill or health insurance policy. Refrain from mailing any original documents, as they may get lost.
- Pay the dispute administrative fee. There is a fee of $25 that you must pay at the time you file the dispute. If the dispute is found in your favor, your medical bill will be reduced by $25.
- Wait for an answer. Once the dispute is reviewed, you will receive a response, usually via mail. If the dispute is in your favor, the medical provider will be required to lower their costs to what the third party found to be an appropriate amount.
The hospital cannot send your medical bills to collections during the dispute. Also, the medical provider cannot add on any late fees or penalties. If you and the medical provider reach an agreement before the dispute is completed, be sure to contact the third party reviewing your situation to let them know.
The Importance of Keeping Records
When you visit a healthcare provider, keeping accurate records of your transactions is essential. When you receive services, you should be given an explanation of their billing procedures or an estimate of the services. Don’t lose that paperwork in case you need it later on.
Keep any medical bills you receive as well. Contacting the medical provider and asking for an itemized bill may be a good idea. This bill will have a more thorough billing breakdown and specific codes.
Lastly, it is crucial to be familiar with your health insurance plan. A copy of that plan or your insurance card may be needed when you receive services. If you file a dispute, you may be asked to provide a copy of your policy.