Protecting Yourself from Surprise Out-of-Network Medical Bills: A Guide to the No Surprises Act

Introduction:
Navigating the healthcare system can be daunting, especially when faced with unexpected medical expenses. This blog post will provide valuable information about the No Surprises Act (NSA) and how it can protect you from surprise out-of-network billing, particularly in the context of ACA health insurance.

Understanding the No Surprises Act (NSA)

The NSA is a federal law enacted in 2022 that protects patients from surprise medical bills. This law applies to all health insurance plans, including ACA Marketplace plans. Under the NSA, patients cannot be charged more than their in-network copayments and deductibles for out-of-network services provided at in-network facilities.

Key Provisions of the NSA:

Protects against balance billing: Out-of-network providers cannot bill patients for the difference between the in-network and out-of-network rates.
Applies to emergency services: The NSA applies to all emergency services, regardless of whether the patient is in-network or out-of-network.
Applies to non-emergency services at in-network facilities: If a patient receives non-emergency services at an in-network facility but is treated by an out-of-network provider, the NSA protects the patient from balance billing.

How to Protect Yourself from Surprise Out-of-Network Bills

Before Your Surgery:

Verify your provider’s network status: Confirm that your surgeon and all other healthcare providers involved in your surgery are in-network with your health insurance plan.
Get a written estimate: Ask your doctor or hospital for a written estimate of all the costs associated with your surgery, including both in-network and out-of-network services.
Contact your insurance company: Call your insurance company to inquire about any prior authorizations that may be required for your surgery.

During Your Surgery:

Inform the hospital of your insurance coverage: Make sure the hospital staff is aware of your health insurance plan and network status.
Ask about out-of-network providers: If you are concerned about potential out-of-network charges, ask the hospital staff if any out-of-network providers will be involved in your care.

After Your Surgery:

Review your bills carefully: Check your bills and Explanation of Benefits (EOB) statements for any out-of-network charges.
Dispute any out-of-network charges: If you are charged more than your in-network copayments and deductibles, dispute the charges with your insurance company.
Seek help from an insurance advocate or state agency: If you need assistance navigating the insurance process or filing a dispute, contact an insurance advocate or your state’s insurance regulatory agency.

Conclusion

The No Surprises Act provides important protections for patients against surprise medical bills. By understanding the law and taking proactive steps before and after your surgery, you can safeguard your financial well-being. Remember, you have the right to accessible and affordable healthcare, and the NSA is designed to help ensure that right.