The No Surprises Act (NSA) went into effect January 1, 2022. The NSA is a federal law to protect consumers from surprise bills. The NSA applies to most types of health insurance and creates requirements protecting you from out of network bills from, Emergency Room visits, non-emergent care, and all Air Ambulance services. These requirements apply to healthcare providers, facilities, and providers of air ambulance services.
The law applies to anyone enrolled in group health plans or individual health insurance coverage receiving services for medical care. The NSA states health care providers must offer a notice of consent for patients, which discloses exclusions about balance billing and patient protections. This also includes Federal Employee Health Benefit plans. Additionally, the NSA also requires providers and facilities to give good faith estimates to patients who do not have or are not using insurance. The NSA also explains the patient-provider dispute resolution process and how it may apply to services you receive as a patient.
What is “balance billing” or “surprise billing”?
“Surprise billing" is an unexpected bill for the balance of charges not covered by insurance. This can happen when you have an emergency or when you schedule a visit at an in-network facility but are treated by an out-of-network provider. Surprise medical bills can cost thousands of dollars depending on the service.
When you see a healthcare provider, you may owe specified out-of-pocket costs, like a copayment, coinsurance, or deductible. If your provider or healthcare facility is not in your health plan's network, you may have additional costs or pay the entire bill.
For the most part, our Michigan Medicine providers are employed by the hospital and authorized by insurers to perform services at Michigan Medicine. If Michigan Medicine is in your health plan’s network, then it’s likely that your provider will also be considered “in network.” If you are unsure, ask your provider if they are “in-network” with your insurance plan before scheduling services at Michigan Medicine.
The NSA ensures you are protected from balance billing for:
Emergency services
If you receive emergency services from an out-of- network provider or facility, the maximum they can bill you is your plan's in-network cost-sharing amount. You can’t be balance billed for these services. This includes services you may get after you are in stable condition (you cannot to be balanced billed for post-stabilization services).
When balance billing is not allowed, you also have other protections:
- You are only responsible for paying your share of the insurance cost (like the copayments, coinsurance, and deductible) that you would pay if the provider or facility was in-network. Your health insurance plan will directly pay any additional costs to providers and facilities.
- Your health insurance plan is required to:
- Cover emergency services without requiring approval in advance (“prior authorization”)
- Cover out-of-network providers for emergency services.
- Determine what you owe the provider or facility (cost-sharing) based on in-network provider/facility and display that amount in your explanation of benefits (EOB).
- Count any amount you pay for out-of-network emergency services or out-of-network facility services toward your cost share provisions of your insurance plan.
Patients have the right to receive a “good faith estimate” explaining how much your healthcare will cost.
Healthcare providers are required to give patients an estimate of their bill for healthcare services before services are provided.
- Your right to receive a good faith estimate for the total anticipated cost of any healthcare or services upon request or when scheduling services. This includes related costs of tests, prescription drugs, and hospital fees.
- If you schedule a healthcare service at least 3 business days in advance, your healthcare provider creates a good faith estimate in writing within 1 business day (after scheduling).
- If you schedule a healthcare service 10 business days in advance, your good faith estimate should be provided 3 business days (after scheduling).
- You can also request a good faith estimate before you schedule any service. Again, the good faith estimate should be provided 3 business days (after your request).
For questions or more information about your right to a good faith estimate, visit cms.gov/medical-bill-rights, email [email protected] or call 1-800-985-3059.
Believe you have been wrongly billed?
For more information about your rights under federal law, visit Centers for Medicare & Medicaid Services (CMS) at cms.gov/medical-bill-rights
You may also contact the No Surprises Help Desk by calling 1-800-985-3059. This is a CMS resource Help Desk that can guide you through all aspects of the NSA.
Dispute a bill
If you receive a bill which is at least $400 more than your good faith estimate, you can dispute the bill. You must initiate a dispute within 120 days of receiving your initial bill. For more information, visit the CMS website “dispute a bill.”