What is surprise billing?
The National Association of Insurance Commissioners (NAIC) defines surprise billing as when a patient unknowingly or unavoidably receives health care from providers outside their insurance company’s network and is billed directly for that care.
This could have left you with higher costs than if you got care from an in-network provider or facility.
In addition to any out-of-network cost sharing you might have owed, the out-of-network provider or facility could bill you or the difference between the billed charge and the amount your health plan paid, unless banned by state law.
Can this affect me?
In 2022, the No Surprises Act (NSA) took effect. This act covers surprise bills for covered emergency out-of-network services, and surprise bills for covered non-emergency services at an in-network facility. The NAIC states:
If you get health coverage through your employer, a Health Insurance Marketplace or an individual health insurance plan you purchase directly from an insurance company, the No Surprises Act will:
Some health insurance coverage programs already have protections against surprise medical bills. If you have coverage through
You don’t need to worry because you’re already protected against surprise medical bills from providers and facilities that participate in these programs.
What if I get a surprise bill?
If you’ve received a surprise bill that you think isn’t allowed under the new law, you can
You still can agree in advance to be treated by an out-of-network provider in some situations, such as when you choose an out-of–network surgeon knowing the cost will be higher. The provider must give you information in advance about what your share of the costs will be. If you did that, you’d be expected to pay the balance bill as well as your out-of-network coinsurance, deductibles, and/or copays.
At our agency, we take your privacy seriously. Unlike big insurance agencies that sell your information to high-pressure agents, we only use it to connect with you personally. This way, we can ensure that you get a plan that's tailored specially for you.