No Surprises Act Prevents Medical Bill Surprises
A doctor in an exam room writes on a piece paper on a clip boardNobody enjoys getting a bill, but it's twice as unwelcome to get a bill you weren't anticipating. Most Americans either have experienced receiving a surprise medical bill themselves or know someone who has. A recent survey found that an average of 18% of ER visits result in at least one unexpected bill. But there is some relief: Congress passed the No Surprises Act that went into effect on January 1, 2022 to specifically prevent these kinds of unwanted surprises. Laws regarding surprise medical bills - particularly new ones, like the No Surprises Act - can be confusing and tricky to navigate, particularly if you have recently received an unexpected medical bill. Our network of dedicated, experienced attorneys can walk you through the consumer protections of the No Surprises Act and what to do if you get a surprise medical bill. Learn more about our legal protection plans and read on for an overview of the No Surprises Act.
The New Rules of the No Surprises Act
The Act bans surprise bills stemming from emergency care - such as treatment in an ER, ambulances, or when you are unknowingly treated at an in-network facility but by an out-of-network physician - and requires that co-pays and other cost sharing be determined by in-network rates.
The Act prohibits unexpected billing from out-of-network providers if you go to an in-network hospital for care, and any cost sharing from those visits will be determined from in-network rates.
The Act requires that facilities and providers send straightforward notices that explain all applicable billing, protections, and contact information.
Consumer Protections for Uninsured Patients
Uninsured patients are considered self-paying and must cover all bills out-of-pocket. The No Surprises Act protects uninsured patients by requiring providers to give a "good faith estimate" of total costs before giving you non-emergency care. This estimate must include projected costs for treatment as well as any expected additional costs. If the final bill you receive exceeds the good faith estimate by more than $400, you have the right to challenge the charges.
Your State May Provide Additional Protections
More than 30 states have introduced safeguards against surprise medical billing, but only 17 are considered comprehensive. These 17 states offer extended protections that cover in-network emergency situations, but they only apply to certain types of insurance and in specific scenarios.
While Federal laws cover most insurance plans, some state law provisions may differ from Federal law, and in those cases, Federal laws defer to the states.
If you have questions about a medical bill you received or want to find out if the No Surprises Act can help you with a medical bill, you can contact your attorney through our network of lawyers using your subscription to our legal protection plans any time of the day or night, 24/7 using our app or by telephone. And at just $29.95 per month, it pays for itself the very first time you use it. Your attorney can give you advice on the consumer protections as they relate to your specific situation, including your insurance, your state law, and even write letters or make phone calls on your behalf. Learn more about all the benefits of membership in our legal subscription plans or sign up now!
