What is the No Surprise Act?

What is the No Surprise Act?

No Surprise Act – What you need to know!

The No Surprise Act (NSA) is a new law which became effective on January 1st 2022. This Act is designed to protect insured patients from surprise medical bills, particularly in situations where patients received medical care from out-of-network providers without their knowledge or consent.

A great example of this is when a patient receives care at an in-network hospital or clinic with their insurance, but some providers or services involved in their care are not part of the patient’s insurance network, or in insurance lingo, are “out of network”. Common examples are providers such as anesthesiologists or radiologists, services such as labs and even emergent care such as air ambulance or hospital emergency room services. In these situations, the law limits out-of-network care at in-network rates.

Due to this being a new law, healthcare providers and insurance companies are working hard to implement new processes to adhere to these new standards, however mistakes can occur. As such it is important that families and patients are knowledgeable of this law and carefully examine any bills with patient balances due to out-of-network services. 

Doctor giving child a shot

How to ensure my medical bills are accurate?

There are three easy steps to follow to ensure any medical bills you or your family receive are accurate under the No Surprise Act:

  1. Carefully review all medical bills with patient responsibility: Match the bill from the provider to the explanation of benefits (EOB) from your insurance carrier to confirm if the bill was processed at an in-network or out-network. If the claim was processed at out-of-network rates and the care was due to any of the below reasons, the bill is potentially inaccurate under the No Surprise Act.
    • Emergency Room Visits
    • Non-emergency care related to a visit to an in-network hospital, outpatient clinic or ambulatory surgical center
    • Air ambulance services
  2. Contact your insurance company to reprocess the claim: Contact your insurance company and inform them that you believe this claim qualifies under the No Surprise Act, providing helpful information regarding the emergent or supplemental care that should not be processed at out-of-network rates.
  3. Contact the provider (who sent the bill with patient responsibility): Contact the provider who sent the bill, informing them that the insurance company is re-processing the claim. Also, inform them that this claim qualifies for the No Surprise Act and should not be billed to the patient at these rates. Ask for your account to be updated and for the bill to be placed on hold, to prevent any additional statements or involvement with collection agencies. 

      Typically, the above steps will result in the medical claim and bill being updated accurately, however if this does resolve the bill accurately and you feel the law isn’t being followed accurately, contact the Centers for Medicare & Medicaid Services No Surprise Help Desk. You can find helpful information on the Act as well as contact information here

      The financial burden on families facing pediatric cancer can be immense, as the average cost for a day in the hospital is reported at over $40,000 per day. Ensuring insurance company is processing your medical claims and any patient/guarantor responsibility accurately can help to reduce the cost and remove some stress. 

      At Here to Serve, we provide resources to assist families in facing the pediatric cancer journey. Check out the wide range of our services and consider donating to cancer nonprofits like Here to Serve to help support families at the most difficult time of their lives.

      About the Author:

      A Board Member for Here to Serve, Jennifer Doner is a healthcare business leader who is passionate to improve health and well-being through advancing business strategy and driving innovation in the healthcare system. 

      Information on the Here to Serve website is for educational and informational purposes only. Please consult a medical professional for specific medical guidance.