No Surprises Act
Starting January 1, 2022, the
No Surprises Act will protect certain patients from surprise bills for emergency services
at nonparticipating facilities, services provided by nonparticipating
providers at participating facilities, and air ambulance services from
nonparticipating providers. The No Surprises Act also enables uninsured
or self-pay patients to receive a good faith estimate of the cost of scheduled
care ahead of time.
Balance Billing Disclosure
Your Rights and Protections Against Surprise Medical Bills
When you get emergency care or are treated by an out-of-network provider
at an in-network hospital or ambulatory surgical center, you are protected
from balance billing if you are enrolled in a group health plan, group
or individual health insurance coverage, or a Federal Employees Health
Benefits Plan. In these cases, you shouldn’t be charged more than
your plan’s copayments, coinsurance and/or deductible.
What is “balance billing” (sometimes called “surprise
When you see a doctor or other health care provider, you may owe certain
out-of-pocket costs, like a
deductible. You may have additional costs or have to pay the entire bill if you see
a provider or visit a health care facility that isn’t in your health
“Out-of-network” means providers and facilities that haven’t
signed a contract with your health plan to provide services. Out-of-network
providers may be allowed to bill you for the difference between what your
plan pays, and the full amount charged for a service. This is called “balance
billing.” This amount is likely more than in-network costs for the
same service and might not count toward your plan’s deductible or
annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can
happen when you can’t control who is involved in your care—like
when you have an emergency or when you schedule a visit at an in-network
facility but are unexpectedly treated by an out-of-network provider. Surprise
medical bills could cost thousands of dollars depending on the procedure
You’re protected from balance billing for:
If you have an emergency medical condition and get emergency services from
an out-of- network provider or facility, the most they can bill you is
your plan’s in-network cost-sharing amount (such as copayments,
coinsurance, and deductibles). You can’t be balance billed for these
emergency services. This includes services you may get after you’re
in stable condition, unless you give written consent and give up your
protections not to be balanced billed for these post-stabilization services.
Certain services at an in-network hospital or ambulatory surgical center
When you get services from an in-network hospital or ambulatory surgical
center, certain providers there may be out-of-network. In these cases,
the most those providers can bill you is your plan’s in-network
cost-sharing amount. This applies to emergency medicine, anesthesia, pathology,
radiology, laboratory, neonatology, assistant surgeon, hospitalist, or
intensivist services. These providers can’t balance bill you and
may not ask you to give up your protections not to be balance billed.
If you get other types of services at these in-network facilities, out-of-network
providers can’t balance bill you unless you give written consent
and give up your protections.
You’re never required to give up your protections from balance billing.
You also aren’t required to get out-of-network care. You can choose
a provider or facility in your plan’s network.
When balance billing isn’t allowed, you also have these protections:
- You’re only responsible for paying your share of the cost (like the
copayments, coinsurance, and deductible that you would pay if the provider
or facility was in-network). Your health plan will pay any additional
costs to out-of-network providers and facilities directly.
Generally, your health plan must:
- Cover emergency services without requiring you to get approval for services
in advance (also known as “prior authorization”).
- Cover emergency services by out-of-network providers.
- Base what you owe the provider or facility (cost-sharing) on what it would
pay an in-network provider or facility and show that amount in your explanation
- Count any amount you pay for emergency services or out-of-network services
toward your in-network deductible and out-of-pocket limit.
If you think you’ve been wrongly billed, you may:
www.cms.gov/nosurprises for more information about your rights under federal law.
Good Faith Estimate Disclosure
You have the right to receive a “Good Faith Estimate” explaining
how much your medical care will cost
Under the law, health care providers need to give
patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
- You have the right to receive a Good Faith Estimate for the total expected
cost of any non-emergency items or services. This includes related costs
like medical tests, prescription drugs, equipment, and hospital fees.
- Make sure your health care provider gives you a Good Faith Estimate in
writing at least 1 business day before your medical service or item. You
can also ask your health care provider, and any other provider you choose,
for a Good Faith Estimate before you schedule an item or service.
- If you receive a bill that is at least $400 more than your Good Faith Estimate,
you can dispute the bill.
- Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit
www.cms.gov/nosurprises or call 1-800-985-3059.
Health Plan Network Status
Livingston HealthCare accepts many but not all insurance plans so there
is a good chance that your physician and hospital insurance coverage is
welcome here. To learn more about insurance plans that are participating