Your rights under the No Surprises Act

It’s a familiar story — a necessary trip to the emergency room that yields an astronomical bill because the on-call physician or the facility aren’t part of your health insurance network. Or maybe you undergo a scheduled procedure with an in-network surgeon, but an out-of-network surgical assistant leaves you on the hook for thousands.

The No Surprises Act, which went into full effect at the beginning of this year, establishes new federal protections against these kinds of surprise charges, also called “balance bills,” according to Healthline. The new rules require private insurers and providers to negotiate balance bills directly, and if a fair reimbursement rate can’t be negotiated, an independent arbiter is called in to settle the dispute. Importantly, the patient is no longer part of the equation.

According to the Centers for Medicare and Medicaid Services, the No Surprises Act bans surprise bills for most emergency services, out-of-network cost sharing charges for most emergency and some non-emergency services, and balance billing and out-of-network charges for additional services (such as anesthesiology and radiology at an in-network facility). The law also requires providers and facilities to provide good-faith treatment cost estimates for patients who are uninsured or self-pay. A bill that exceeds $400 above the good-faith estimate can be disputed within 120 days.

While the bill eliminates balance billing for air ambulance services, patients are still liable for balance bills for ground ambulance services, according to the Kaiser Family Foundation. The law mandates the creation of a federal advisory committee to study the issue and make recommendations, but meanwhile, about half of emergency ground ambulance rides result in out-of-network charges for privately insured patients.