Billing
Consumer protections from surprise billing
What are the protections under the 2022 No Surprises Act?
Whether you have health insurance or are currently uninsured, the No Surprises Act ensures you can get costs estimated before you receive medical services to help you avoid surprise bills.
Consumers with health insurance can get these estimates from their health plan. Uninsured consumers can get “good faith” estimates from their health care providers and facilities before they get care.
For consumers who have health coverage through their employer (including federal, state or local government), through the Health Insurance Marketplace® or directly from an individual health plan, beginning January 2022, the No Surprise Act protections will:
- Ban surprise billing for emergency services. Emergency services, even if they’re provided out-of-network, must be covered at an in-network rate without requiring prior authorization.
- Ban balance billing and out-of-network cost sharing (e.g., out-of-network coinsurance or copayments) for emergency and certain nonemergency services. In these situations, the consumer’s cost for the service cannot be higher than if these services were provided by an in-network provider, and any coinsurance or deductible must be based on in-network provider rates.
- Ban out-of-network charges and balance billing for ancillary care (e.g., an anesthesiologist or assistant surgeon) by out-of-network providers at an in-network facility.
- Ban certain other out-of-network charges and balance billing without advance notice. Health care providers and facilities must provide consumers with a plain-language consumer notice explaining that patient consent is required to get care on an out-of-network basis before that provider can bill the consumer.
These rules don’t apply to consumers with coverage through Medicare, Medicaid, Indian Health Services, Veterans Affairs Health Care or TRICARE because these programs have other protections against high medical bills.
For consumers who don’t have insurance, these rules will help them estimate how much their health care might cost, and may help if they get a bill that’s larger than expected.
More information about your rights
- Your Right to Receive a Good Faith Estimate of Expected Medical Costs
Spanish | Arabic | Vietnamese | Tagalog | Chinese - Your Rights and Protections Against Surprise Medical Bills
Spanish | Arabic | Vietnamese | Tagalog | Chinese
If you would like to request a translation in a language that is not already available, please email your request to pfsprivate.pay@sharp.com.
