What Are Your Key Protections?
The No Surprises Act, effective since January 1, 2022, provides federal protections against surprise medical bills. This typically happens when you unknowingly get care from a provider that is outside your health plan's network. Here’s what’s covered.
Emergency Services
You are protected from surprise bills for most emergency services, even if they are at an out-of-network facility or from an out-of-network provider. Your cost-sharing (like co-pays) can't be higher than your plan's in-network rates.
Certain In-Network Facility Services
If you go to an in-network hospital or surgical center, you are protected from surprise bills from out-of-network providers who may be involved in your care, such as anesthesiologists, pathologists, or radiologists.
Air Ambulance Services
You are protected from surprise bills from out-of-network air ambulance providers. However, it's important to note that ground ambulance services are **not** currently covered by this federal law.
Good Faith Estimates for the Uninsured or Self-Pay
If you are uninsured or choose not to use your insurance for a service, you have the right to receive a "Good Faith Estimate" (GFE) of the expected cost of your care before you receive it. This helps you understand and plan for the costs upfront.
What's in a Good Faith Estimate?
- Patient's name and date of birth.
- A clear description of the primary service or item.
- An itemized list of all other services or items that are reasonably expected to be provided as part of the same care.
- Applicable diagnosis and service codes.
- The expected charge for each item or service.
- Name and NPI of each provider.
- A disclaimer explaining that this is an estimate and actual costs may vary.
What if Your Bill is Higher Than Your Estimate?
The Good Faith Estimate gives you a powerful tool. If your final bill from a provider is significantly higher than their estimate, you may be able to dispute it through the official Patient-Provider Dispute Resolution (PPDR) process.
The Dispute Resolution Decision Tree
1. Compare Your Bill to the GFE
Is the final bill from a single provider or facility at least $400 more than the amount on their Good Faith Estimate?
2. Check the Timeline
Has it been less than 120 calendar days since the date on your initial bill?
You are Eligible to Start the Dispute Process!
You can initiate the PPDR process through the official online portal. There is a $25 administrative fee to start the process.
How to Take Action
If you believe your rights have been violated or you have questions, there are official channels to get help. You should always start by contacting your provider and health plan, but if that doesn't work, here's what to do.
Contact the No Surprises Help Desk
For questions or to file a complaint about a potential violation, you can contact the official help desk.
📞
Call Them
1-800-985-3059