The No Surprise Act (NSA) is a piece of legislation that began this year. This act offers protections by the government against surprise medical bills. But what defines a “surprise medical bill?” Any bill that comes from an out-of-network provider or facility as well as any out-of-network cost sharing you may have owed (out-of-network coinsurance or copayments).
With the NSA now in effect, there is a ban on:
- Surprise bills for emergency services from out-of-network providers or facilities;
- Out-of-network cost-sharing, like out-of-network coinsurance or copayments, for all emergency and some non-emergency services;
- Out-of-network charges and balance bills for supplemental care, like radiology or anesthesiology, by out-of-network providers that work at an in-network facility; and
- Air ambulances, (helicopter or airplane), under the new law a patient will pay only the deductible and co-payments, note, this law does NOT apply to ground ambulances that travel on roads.
Some people can be afraid to go to an emergency room when they have been injured because of the potential costs involved. We have all heard the horror story of a trip to the emergency room ending in bills that lead to Bankruptcy. A surprise medical bill(s) from emergency room visits occurred in approximately 20% of visits to an ER. But the NSA protections will serve to give confidence of an insured person’s choice to go to the doctor or seek immediate medical assistance without concern that they will be financially penalized for doing what is best for them.
There is an interesting component to this legislation that still deserves mentioning. Everything thus far only pertains to those who HAVE health insurance. But in the NSA, there is a new protection for those WITHOUT health insurance. The NSA requires medical workers to give you a “good faith” estimate of how much your care will cost prior to getting the care you need. Then, if the services provided exceed the good faith estimate by $400.00 or more, you have options to dispute the charges. This dispute would have to occur within 120 days of receiving the estimate-excessive “surprise” bill. While health care providers CAN ask you to waive your NSA rights, emergency services and certain other non-emergency services CANNOT be waived. Period.
These aspects of the NSA are great news! This is a pro-consumer plan that operates similar to how Medicare and Medicaid already operate. While you can start your own dispute for a surprise medical bill here, we at Rittgers Rittgers & Nakajima have extensive experience assisting clients as they navigate their medical expenses and recover from injury. We work daily to assist clients with the numerous hurdles encountered when injured by another’s negligent conduct.
If you, a family member, friend, or co-worker, have been injured by someone’s negligence, please contact Rittgers Rittgers & Nakajima for a free consultation of your rights. We are here to help.