No Surprises Act
What you need to know about the No Surprises Act starting January 1, 2022.
What is surprise billing?
Surprise billing is an unexpected medical bill. It happens when you cannot control who’s involved in your care, such as when you receive care during a medical emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.
When an out-of-network provider bills you for the difference between what the insurer pays and what the provider charges, this is called "balance billing."
The NSA will protect you from being balance billed in these situations
Out-of-network providers and facilities cannot balance bill you for covered services you receive resulting from a medical emergency. The most they can charge you is your in-network cost share.
This includes covered services you receive once you're in stable condition, unless you give written consent removing these protections.
Certain services at an in-network hospital or ambulatory surgical center
Out-of-network providers who work at in-network hospitals or ambulatory surgical centers cannot balance bill you for covered services. The most they can charge you is your in-network cost share unless you give written consent removing these protections.
These providers cannot ask you to give up your protections through written consent:
- Emergency medicine
- Assistant surgeon
- Hospitalist or intensivist services
What are we doing to help?
Ways we have you covered:
When you are protected by the NSA, you only have to pay your applicable in-network cost share, such as your copay, coinsurance and/or deductible. We will pay out-of-network providers and facilities directly and provide you with an Explanation of Benefits (EOB) that clearly outlines your financial responsibility.
We will cover emergency services without requiring you or your provider to get prior approval.
We will also count any amount you pay for NSA-protected claims toward your in-network deductible and out-of-pocket maximum (the most you will pay for covered services during the year).
If you feel you’ve been billed incorrectly, you can call the customer service number on the back of your member ID card or find it here.