What is the No Surprises Act?
Why was the No Surprises Act created?
Do you hate surprises? Me too! Well… I hate some surprises. I hate when someone jumps out at me from around the corner and I scream. I hate when I hate when there is a surprise bug in the shower. I hate when the in-laws stop by unannounced. But the surprise I hate the most is a surprise bill!
That is exactly why the No Surprises Act was developed…so you no longer will receive a surprise bill!
What exactly is the No Surprises Act?
Under the “No Surprises Act” effective 1/1/2022, you have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
• You have the right to receive a “Good Faith Estimate” explaining how much your medical and health care will cost.
• Health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including speech therapy services. You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service.
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
• Make sure to save a copy or picture of your Good Faith Estimate.
New Surprise Billing Requirements and Prohibitions
• No balance billing for out-of-network emergency services
• No balance billing for non-emergency services by out-of-network providers during patient visits to certain in-network health care facilities, unless notice and consent requirements are met for certain items and services.
• Providers and health care facilities must publicly disclose patient protections against balance billing
• No balance billing for covered air ambulance services by out-of-network air ambulance providers
• In instances where balance billing is prohibited, cost sharing for insured patients is limited to in-network levels or amounts
• Providers must give a good faith estimate of expected charges to uninsured and selfpay patients at least 3 business days before a scheduled service, or upon request
• Plans and issuers and providers and facilities must ensure continuity of care when a provider’s network status changes in certain circumstances
• Plans and issuers and providers and facilities must implement certain measures to improve the accuracy of provider directory information
More Questions?
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises, call (720) 845-6600 or schedule a free consultation at Embodied Wellness, PLLC.