No Surprises Act
Your Rights and Protections Against Surprise Bills
No Surprises Act Overview
Patients are protected from receiving surprise medical bills resulting from out-of-network care for emergency services and for certain scheduled services without prior patient consent.
Patients are protected from receiving surprise medical bills resulting from out-of-network care for emergency services and for certain scheduled services without prior patient consent.
Patients who do not have insurance or who are not using insurance to pay for care have a right to receive a Good Faith Estimate (GFE) of their potential bill for medical services when scheduled at least three (3) days in advance.
Individuals with Medicare, Medicare Advantage, Medicaid, Indian Health Services, VA healthcare, or TRICARE insurance plans are not covered under the No Surprises Act because these federal insurance programs have existing protections in place to minimize large, unforeseen bills.
Surprise Medical Bills
Unforeseen medical bills can happen when a patient receives emergency or scheduled clinical care or services from a provider or facility that is considered out of network or non-participating by that patient's insurance plan. These surprise bills are often called "balance billing" or "out-of-network billing."Balance billing occurs when a provider sends a bill to a patient to cover the difference between what the insurance plan agreed to pay the provider and the full cost for a service.
Out-of-network costs happen when a patient receives care from a facility or provider not participating in that patient's insurance plan. This may result in a higher patient cost than if the patient were seen by an in-network provider or facility.
The No Surprises Act reduces instances where patients face unexpected medical bills due to receiving care from an out-of-network facility or provider during an emergency. Similarly, patients are protected from receiving surprise bills for certain scheduled services for which they could not reasonably know the network status of a provider. For certain scheduled care with out-of-network providers, patients must be given appropriate notice and give approval, where applicable, to be billed for any applicable out-of-network fee or amount.
Get a Cost of Care Estimate
Uninsured and self-pay patients have a right to receive a Good Faith Estimate (GFE) ahead of scheduled non-emergency healthcare services. A Good Faith Estimate shows the cost of items and services that are reasonably expected for your healthcare needs. The estimate is based on information known at the time the estimate was created, and can include costs related to your visit such as medical tests, medications, equipment, and hospital fees.Healthcare providers should give you the estimate in writing at least one (1) day before your medical service if your care has been scheduled at least three (3) days in advance. You may also request an estimate at any time.
For questions about the law or more information about your right to a Good Faith Estimate, visit https://www.cms.gov/nosurprises or call (800) 985-3059.
As an additional resource, you may also use the Mt. San Rafael Hospital Pricing Estimator using the link below. However, patients can also direct their questions to a Financial Counselor at (719) 845-4204 or your health insurance company representative.