No Surprises Act

The No Surprises Act (NSA), signed into law as part of the Consolidated Appropriations Act of 2021 (CAA), establishes federal standards to protect patients with health benefits coverage from “surprise” medical bills that may arise when receiving care from certain out-of-network providers and ancillary providers. It is designed to protect patients from surprise bills for emergency services at out-of-network facilities or for out-of-network providers at in-network facilities. Under the NSA, patients will only be responsible for paying the in-network amount for covered services (at certain facilities). The No Surprised Act also enables uninsured patients to receive a good faith estimate of the cost of care.

SURPRISE BILLING OR BALANCE BILLING

Surprise bills include the practice of balance billing where providers may charge the difference between what the patient’s plan pays and the amount originally billed by the health provider. Under the NSA, the patient would need to pay only for the any coinsurance or deductibles they would normally pay for in-network providers.

PROTECTS AGAINST BALANCE OR SURPRISE BILLING FOR:

  • Most emergency services including post-stabilization services.

  • Non-emergency care from out-of-network providers (such as anesthesiologists or pathologists) at in-network facilities (hospitals and surgery centers).

  • Out-of-network air ambulance companies.

You're never required to give up your protections from balance billing. You also aren't required to get care out-of-network. You can choose a provider or facility in your plan’s network.

If you believe you’ve been wrongly billed, you may contact:

Dr. Jared Abbott, M.D., Goldfinch Laboratory Compliance Officer, 4637 121st St, Urbandale, IA 50323 (phone 515-655-7080).

Visit www.cms.gov/nosurprises for more information about your rights under federal law.

GOOD FAITH ESTIMATE

Under the No Surprises Act, healthcare providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical services.

Your Rights Under the Good Faith Estimate:

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment and hospital fees.

  • Make sure your healthcare provider gives you a Good Faith Estimate in writing at least one business day before your medical service or item. You can also ask your healthcare 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 can dispute the bill.

  • Make sure to save a copy of your Good Faith Estimate.

GET MORE INFORMATION:

For questions or more information about your right to a Good Faith Estimate, contact Jared Abbott, M.D., Goldfinch Laboratory Compliance Officer, 4637 121st St, Urbandale, IA 50323 (phone 515-655-7080) or visit cms.gov/nosurprises or call 1-800-MEDICARE (1-800-633-4227).