No More Surprises

The No Surprise Act and Good Faith Estimates

Understanding your health insurance can seem overwhelming at times, especially during an emergency.

Too often, we hear stories of patients who unknowingly visit an out-of-network doctor or emergency room when traveling, only to be surprised by large medical bills when they get home.

Thanks to the No Surprise Act, which went into effect January 1, 2022, these surprise medical bills are now a thing of the past.

The No Surprise Act

The No Surprise Act protects patients from surprise medical bills that arise when they unintentionally receive care from out-of-network hospitals, doctors or `other providers they did not choose. It does this by:

• Requiring private health plans to cover these out-of-network claims and apply in-network cost-sharing.
• Prohibiting doctors, hospitals, and other covered providers from billing patients more than in-network cost-sharing amounts.
• Establishing a process for determining the payment amount of surprise, out-of-network medical bills. This process begins with negotiation between plans and providers.

Good Faith Estimate

The No Surprise Act also protects patients who don’t have or are not using insurance. It requires healthcare providers to give these individuals a Good Faith Estimate of the bill for medical items and services. Important things to know about Good Faith Estimates:

They will include the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

• They should be received in writing at least 1 business day before the medical item or service.
• You have the right to request an estimate before an item or service is even scheduled.
• Make sure to save a copy or picture of your Good Faith Estimate.

For more information on the No Surprise Act and Good Faith Estimate, visit www.cms.gov/nosurprises or call 1.800.985.3059.