No Surprises Act
Beginning January 1, 2022, healthcare facilities must provide a good faith estimate of expected charges to uninsured consumers, or to insured consumers if the patient does not plan to have their health plan help cover the costs (self-paying individuals). The good-faith estimate must be provided after a patient has scheduled a surgery, or upon their request. It should include expected charges for the primary item or service they’re getting, and any other items or services that are provided as part of the same scheduled experience.
“Surprise billing” is an unexpected balance bill. “Out-of-network” describes a facility that has not signed a contract with your health plan. If you have an emergency medical condition and get emergency services, the most the facility may bill to you is the in-network cost-sharing amount
As the patient, you have the following protections:
You are responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network).
Your health plan generally must:
- Cover emergency services without requiring you to get approval for services in advance (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 of benefits.
If you believe you’ve been wrongly billed, you may contact www.cms.gov/nosurprises for more information about your rights under federal law.
Good Faith Notice
OMB Control Number: 0938-1401
Expiration Date: 12/31/2022
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: