The No Surprises Act (NSA) went into effect January 1, 2022. The NSA is a federal law to protect consumers from surprise bills. The NSA applies to most types of health insurance and creates requirements protecting you from out of network bills from, Emergency Room visits, non-emergent care, and all Air Ambulance services. These requirements apply to healthcare providers, facilities, and providers of air ambulance services.
The law applies to anyone enrolled in group health plans or individual health insurance coverage receiving services for medical care. The NSA states health care providers must offer a notice of consent for patients, which discloses exclusions about balance billing and patient protections. This also includes Federal Employee Health Benefit plans. Additionally, the NSA also requires providers and facilities to give good faith estimates to patients who do not have or are not using insurance. The NSA also explains the patient-provider dispute resolution process and how it may apply to services you receive as a patient.
“Surprise billing” is an unexpected bill for the balance of charges not covered by insurance. This can happen when you have an emergency or when you schedule a visit at an in-network facility but are treated by an out-of-network provider. Surprise medical bills can cost thousands of dollars depending on the service.
When you see a healthcare provider, you may owe specified out-of-pocket costs, like a copayment, coinsurance, or deductible. If your provider or healthcare facility is not in your health plan’s network, you may have additional costs or pay the entire bill.
For the most part, our providers are employed by the hospital and authorized by insurers to perform services at Oaklawn. If Oaklawn is in your health plan’s network, then it’s likely that your provider will also be considered “in network.” If you are unsure, ask your provider if they are “in-network” with your insurance plan before scheduling services at Oaklawn.
Emergency services
If you receive emergency services from an out-of- network provider or facility, the maximum they can bill you is your plan’s in-network cost-sharing amount. You can’t be balance billed for these services. This includes services you may get after you are in stable condition (you cannot to be balanced billed for post-stabilization services).
Healthcare providers are required to give patients an estimate of their bill for healthcare services before services are provided.
For questions or more information about your right to a good faith estimate, visit cms.gov/medical-bill-rights, email FederalPPDRQuestions@cms.hhs.gov or call 1-800-985–3059.
If you believe you’ve been wrongly billed, you may contact your health insurer. If your insurer fails to resolve the issue, you may contact the Michigan Department of Insurance and Financial Services at (833) 275-3437 or visit DIFS – Department of Insurance and Financial Services (michigan.gov) to file a complaint.
For more information about your rights under federal law, visit Centers for Medicare & Medicaid Services (CMS) at cms.gov/medical-bill-rights. You may also contact the No Surprises Help Desk by calling 1-800-985-3059. This is a CMS resource Help Desk that can guide you through all aspects of the NSA.
If you receive a bill which is at least $400 more than your good faith estimate, you can dispute the bill. You must initiate a dispute within 120 days of receiving your initial bill. For more information, visit the CMS website “dispute a bill.”