aidarrowcaretcheckclipboardcommenterrorexperienceeyegooglegownmicroscopenavigatepillTimer IconSearchshare-emailFacebookLinkedInTwitterx

What the ‘No Surprises Act’ Means For Your Medical Bills

Kelsey Tyler

Given the lengthy subtext and confusing terms, navigating health insurance can be quite frustrating. And for years, patients have had to go through lengthy means to avoid surprise medical bills. On January 1st, a new law fell into place, making paying for healthcare in the US more transparent. The No Surprises Act will protect Americans from having to pay the around 10 million exorbitant surprise medical bills they get tossed each year. 

This is huge news; Around two-thirds of Americans worry about being unable to pay unexpected medical expenses. Read on to learn more about the law and how it could come to your advantage. 

When do patients typically get hit with surprise medical bills?

Surprise medical bills usually crop up when patients receive care from out-of-network providers they didn’t necessarily choose. Most surprise bills stem from emergency room visits. In fact, the Kaiser Family Foundation estimates surprise bills pop up after around 1 in 5 emergency room visits. 

Additionally, you may receive a surprise bill if you’re hospitalized at an in-network hospital, and an out-of-network anesthesiologist, or other doctor, provides you care while you’re there. 

What are your rights under the No Surprises Act?

At its simplest, the act ensures that if you go to the emergency room, you should only expect to pay whatever deductible or copay you’d pay in-network. You shouldn’t expect any large, surprise bills in the mail after you receive care. 

The act also protects against surprise expenses related to nonemergency procedures. So, if you’re scheduling an appointment for something like a surgery, make sure to do it at an in-network hospital because it then can’t hit you with out-of-network costs.

If for some reason you do want out-of-network care, hospitals are required to notify you at least three days in advance of potential out-of-network costs — including X-rays, drugs, specialist visits — along with comparable in-network options, before you go. 

Are there any exceptions to the No Surprises Act?

Ground ambulances. While air ambulances are prohibited from sending surprise bills, there aren’t any rules applying to ground ambulances just yet. This means you will still have to pay full price if you take an ambulance, even if it’s higher than your in-network cost. 

What if I don’t have insurance?

The law ensures that even if you don’t have insurance you’ll at least be able to get a “good faith” estimate of what your care should cost before you receive it.

What if I have coverage through Medicare or a similar plan?

Have coverage through Medicare, Medicaid, Indian Health Services, Veterans Affairs Health Care, or TRICARE? Then, you’re already protected from surprise medical bills, according to the Centers for Medicare and Medicaid Services.

No comments. Share your thoughts!

Leave a Comment

About us

The Paper Gown, a Zocdoc-powered blog, strives to tell stories that help patients feel informed, empowered and understood. Views and opinions expressed on The Paper Gown do not necessarily reflect those of Zocdoc, Inc. Learn more.