Policies

As of January 1, 2022, consumers have new billing protections when getting emergency care, non-emergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers. Through new rules aimed to protect consumers, excessive out-of-pocket costs are restricted, and emergency services must continue to be covered without any prior authorization, and regardless of whether or not a provider or facility is in-network.

Previously, if consumers had health coverage and got care from an out-of-network provider, their health plan usually wouldn’t cover the entire out-of-network cost. This left many with higher costs than if they’d been seen by an in-network provider. This is especially common in an emergency situation, where consumers might not be able to choose the provider. Even if a consumer goes to an in-network hospital, they might get care from out-of-network providers at that facility.

In many cases, the out-of-network provider could bill consumers for the difference between the charges the provider billed, and the amount paid by the consumer’s health plan. This is known as balance billing. An unexpected balance bill is called a surprise bill.

The Consolidated Appropriations Act of 2021 was enacted on December 27, 2020 and contains many provisions to help protect consumers from surprise bills, including the No Surprises Act under title I and Transparency under title II.

This Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs for an item or service. The estimate is based on information known at the time the estimate was created and does not include any unknown or unexpected costs that may arise during treatment. To learn more go to www.cms.gov/nosurprises.

NOTICE OF SURPRISE BILLING PROTECTION RIGHTS  

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.  Under the law, i.e. “The No Surprises Act,” health care providers need to give patients who don’t have insurance, or who are not using their insurance such as in-network benefits, an estimate of the bill for medical items and services.  You are receiving this notice because either you don’t have insurance, or the provider is out-of-network.  Please note your right to the following:  

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services listed.  It is an estimate only. It isn’t an offer or a contract.  It does not include any information about your health plan such as what it may cover, reimbursement, or if the amount will count towards your deductible or out-of-pocket limit.   . 

• 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 have the right to dispute the bill.    

You may contact the health care provider to let them know the billed charges are higher than the Good Faith Estimate.  You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available.   

You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS).  If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill.   

To learn more and get a form to start the process, go to www.cms.gov/nosurprises or call 1-800-985-3059.