No Surprise Act
Effective January 1, 2022, one feature of the No Surprises Act (NSA) protects you from surprise billing for emergency services if you have a group health plan or group or individual health insurance coverage, and limit amount of:
Surprise bills for emergency services from an out-of-network provider or facility without prior authorization
Out-of-network cost-sharing, like out-of-network coinsurance or copayments, for all emergency and some non-emergency services
Out-of-network charges and balance bills for supplemental care, like radiology or anesthesiology, by out-of-network providers that work at an in-network facility
The No Surprise Act aims to limit the amount you pay out of pocket to a level closer to what you would pay if the healthcare provider were in-network. The Act defines this limit using a recognized market amount or qualifying figure (like the average fee for the service). It generally applies to your insurance plan's co-pay and cost-sharing percentages. Additionally, the Act outlines a process for your insurance company and the provider to settle disputes over the provider's charges, ensuring fair resolution. The Act also requires some healthcare facilities and providers to disclose Federal and State patient protections against balance billing and sets forth complaint processes concerning violations of the protections against balance billing and out-of-network cost sharing.
You will be provided a good faith estimate. A good faith estimate is a list of expected charges before you get health care items or services (procedures, supporting care) from a provider or facility. The good faith estimate isn't a bill. You're only given one if you don't have insurance or aren’t using insurance to pay for your care.
Please check out https://www.cms.gov/medical-bill-rights for more information.
Please ask Jordan about the No Surprises Act if you are looking at doing private pay or using out-of-network insurance.