No Surprises Act

SUMMARY:

The No Surprises Act 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, holding them liable only for in-network cost-sharing amounts. The No Surprises Act also enables uninsured patients to receive a good faith estimate of expected  charges.

 

MORE DETAILS:

Starting January 1, 2022, health care providers will be required by law to give uninsured and self-pay clients a good faith estimate of costs for services when scheduling care or when the client requests an estimate. Under Section 2799B-6 of the Public Health Service Act,  patients have the right to receive a “Good Faith Estimate”  from health care providers and health care facilities explaining how much their medical care will cost. As a result of this legislature, you are protected from ‘surprise’ billing (aka balance billing) when you receive emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center. When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible.  You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn't in your health plan's network (i.e. they are “out of network”). Out-of-network describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.”

 

The No Surprises Act does not apply to Medicaid or Medicare, including when operated through private commercial insurers or through managed care arrangements, as Medicare and Medicaid already prohibit billing patients for the balance of the charges.

 

GET MORE INFORMATION:

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

 

For specific information on your state laws, please contact the insurance commissioner for the state in which you received your care.

Visit https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXVI/Chapter111/Section228 for more information on your rights under MA state law.