The NSA protects you from surprise bills for covered emergency out-of-network services, including air ambulance services (but not ground ambulance services), and surprise bills for covered non-emergency services at an in-network facility.
The law applies to health insurance plans starting January 1, 2022. It applies to the self-insured health plans that employers offer as well as fully-insured plans from health insurance companies.
An emergency facility and emergency provider may not bill you more than your in-network coinsurance, copay, or deductible for emergency services, even if the facility or provider is out-of-network. It is important to note that if your health plan requires you to pay copays, coinsurance, and/or deductibles for in-network care, you will still be responsible for those costs.
The new law also protects you when you receive non-emergency services from out-of-network providers at in-network facilities. An out-of-network provider may not bill you more than your in-network copays, coinsurance, or deductibles for covered services performed at an in-network facility.
You can never be asked to waive your protections and agree to pay more for out-of-network care at an in-network facility for care related to emergency medicine, anesthesiology, pathology, radiology, or neonatology—or for services provided by assistant surgeons, hospitalists, intensivists, or for diagnostic services including radiology and lab services.
You can agree in advance to be treated by an out-of-network provider in some situations, such as when you choose an out-of-network surgeon knowing the cost will be higher. The provider must give you information in advance about what your share of the costs will be. If you did choose the out-of-network provider knowing the anticipated costs, you will be expected to pay the balance bill as well as your out-of-network coinsurance, deductibles, and copays.
If you received a surprise bill that you think is prohibited under the new law, you can:
There is also a federal dispute resolution process available for individuals who are uninsured, in certain circumstances, such as when the actual charges are much higher than the estimated charges.
Other protections in the new law require insurance companies to keep their provider directories updated. The insurance company also must limit your copays, coinsurance, or deductibles to in-network amounts if you rely on inaccurate information in a provider directory.
For questions or more information about your rights under the NSA please visit www.cms.gov/nosurprises/consumers
or call 1-800-985-3059.