YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISEMEDICAL BILLS (OMB Control Number: 0938-1401)
April 6, 2022 The Consolidated Appropriations Act of 2021 established several new requirements to protect consumers from surprise medical bills. These requirements are collectively referred to as “No Surprises” rules. These requirements generally apply to items and services provided to consumers enrolled in group health plans, group or individual health insurance coverage, and Federal Employees Health Benefits plans. This document contains information on frequently asked questions from providers and facilities regarding No Surprises rules, independent dispute resolution, and exceptions to the new rules and requirements.
What are the new requirements and prohibitions of the No Surprises Act? Patients now have new billing protections when getting emergency care, certain non emergency care from out-of-network providers during visits to certain in-network facilities, and air ambulance services from out-of-network providers.
New Surprise Billing Requirements and Prohibitions
No balance billing for out-of-network emergency services
No balance billing for non-emergency services by out-of-network providers during patient visits to certain in-network health care facilities, unless notice and consent requirements are met for certain items and services.
Providers and health care facilities must publicly disclose patient protections against balance billing
No balance billing for covered air ambulance services by out-of-network air ambulance providers
In instances where balance billing is prohibited, cost sharing for insured patients is limited to in-network levels or amounts
Providers must give a good faith estimate of expected charges to uninsured and self pay patients at least 3 business days before a scheduled service, or upon request Plans and issuers and providers and facilities must ensure continuity of care when a provider’s network status changes in certain circumstances
Plans and issuers and providers and facilities must implement certain measures to improve the accuracy of provider directory information
If you have a question about the No Surprises Act or believe the law isn’t being followed, you can take action by: Contacting the Centers for Medicare & Medicaid Services No Surprises Help Desk at 1-800-985-3059 from 8 am to 8 pm EST, 7 days a week, or Submitting a complaint online.