With the No Surprises Act protections fully in effect, consumers and employees will benefit from a range of new safeguards against these unexpected charges and costs. Patricia Kelmar, Director at Health Care Campaigns at U.S. PIRG highlighted a number of these protections and “must know” tips for patients regarding their protections. Highlights from the patient guide are included below:
New protections from surprise medical bills
Patients should not receive a surprise medical bill from an out-of-network provider in the following situations:
- When you receive emergency care in an emergency room
- When you receive any care at an in-network health care facility
- When you are transported by an air ambulance (airplane or helicopter).
Patients admitted to an out-of-network hospital for emergency services cannot be charged out-of-network rates for “post-stabilization” care unless all of the following conditions are met:
- You can travel safely without medical transportation to an in-network facility
- That in-network facility is willing to accept your transfer
- The transfer will not cause you unreasonable burden, and
- You provide written consent to the transfer.
TIP: The No Surprises Act protections do not apply to ground ambulance transportation. You still may receive an out-of-network balance bill for ambulance services. In 10 states — CO, DE, FL, IL, ME, MD, NY, OH, VT, WV — some people have limited protections against ambulance surprise bills. If you live in one of these states, call your insurance department to find out if the protections apply to you.
Location of treatment matters
These protections only apply when you are treated in certain types of health care facilities:
- For emergency care: All hospital emergency rooms, freestanding emergency departments and urgent care centers that are licensed to provide emergency care, whether in or out of your plan’s network.
- For non-emergency care: Hospitals, hospital outpatient departments and ambulatory surgery centers that participate in your plan’s network.
These protections do not apply when you are in other types of health care facilities such as birthing centers, clinics, hospice, addiction treatment facilities, nursing homes or urgent care centers that are not licensed to provide emergency care. In these settings, before treatment, always ask first if this health care facility and its providers are part of your health plan’s covered network.
Ask: “Are you part of my plan’s network?”
Do not ask: “Do you take my insurance?”
Sometimes a provider says it will “take” your insurance but it is not in your insurance plan’s network. What the provider means is that it will send the bill to your insurance plan for you but will still charge you an out-of-network rate.
To review the full patient guide and recommendations, click here.