No Surprises Act

The No Surprises Act (effective January 1, 2022) protects clients from surprise medical bills by banning balance billing for emergency services and certain non-emergency care from out-of-network providers at in-network facilities. Patients are also entitled to "good faith estimates" of costs and can dispute bills that are at least  higher than that estimate. 

 

Important client rights under the No Surprises Act include:

 

• Ban on Emergency Surprise Billing: Out-of-network providers and facilities cannot bill you more than in-network cost-sharing amounts for emergency services, including post-stabilization care.

• Protection at In-Network Facilities: Non-emergency, out-of-network services (like anesthesiology or radiology) at an in-network facility are limited to in-network rates, unless you provide written consent to waive these protections.

• Good Faith Estimate (GFE): Uninsured or self-pay patients have the right to receive a written estimate of expected charges from providers at least one business day before scheduled servic

  • ​If you are billed for more than this Good Faith Estimate, you may have the right to dispute the bill. You may contact the health care provider or facility listed to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available.​​

  • You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill. If you dispute your bill, the provider or facility cannot move the bill for the disputed item or service into collection or threaten to do so, or if the bill has already moved into collection, the provider or facility has to cease collection efforts. The provider or facility must also suspend the accrual of any late fees on unpaid bill amounts until after the dispute resolution process has concluded. The provider or facility cannot take or threaten
    to take any retributive action against you for disputing your bill.

  • There is a $25 fee to use the dispute process. If the Selected Dispute Resolution (SDR) entity reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate, reduced by the $25 fee. If the SDR entity disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.

  • To learn more and get a form to start the process, go to www.cms.gov/nosurprises/consumers or call 1-800-985-3059.

  • For questions or more information about your right to a Good Faith Estimate or the dispute process,visit www.cms.gov/nosurprises/consumers, email FederalPPDRQuestions@cms.hhs.gov, or call 1-800-985-3059.

• Dispute Resolution: If a final bill exceeds the GFE by $400 or more, you may initiate a dispute resolution process within 120 days of the bill date.

• Notice and Consent: Providers must give you a simple, written notice explaining that you are being treated by an out-of-network provider and obtain consent before charging you higher out-of-network rates.

• Complaints Process: If you believe a provider or facility has violated these rules, you can file a complaint with the Centers for Medicare & Medicaid Services (CMS).

 

The law does not apply to ground ambulance services, and some providers cannot ask you to waive your rights, such as for ancillary services like pathology or radiology.

 

You can learn more about your rights and protections against surprise medical billing HERE.