Home / Blog / Understanding the Federal No Surprises Act

If you suffered serious personal injuries in a car or truck accident, you might be rushed off for emergency treatment at an out-of-network facility or by an out-of-network provider without your consent. This can result in surprise medical bills for costly services that you didn’t expect or plan for.

More than half of American patients have received unexpected medical bills after receiving medical care. Patients also deal with balance billing from providers who have not agreed to accept a health plan’s lower payment rates.

To combat this, the No Surprises Act went into effect on January 1, 2022, establishing federal protections for patients to prevent surprise bills. The law changes how healthcare providers bill and receive reimbursement for out-of-network services.

What is the Federal No Surprises Act?

The No Surprises Act (NSA) limits an individual’s medical expenses to in-network costs and health insurance deductibles for emergency medical services. It also prevents providers from charging for out-of-network services when patients visit an in-network hospital.

Emergency medical services

Surprise bills from air ambulance services, hospitals, freestanding emergency rooms, and licensed urgent care centers are illegal under the new law. Now, patients only pay their health insurance deductibles and copayments for medical emergency services from the initial evaluation to stabilization.

Post-emergency stabilization services

Post-emergency stabilization services are emergency care provided after the patient is out of immediate danger and until the attending physician deems it safe to move the patient to another in-network facility. Other criteria include the new facility being available and open to the patient’s transfer and the transfer not placing a burden on the patient.

Patients must sign a notice and consent form for transfer to another facility. This new regulation ensures the patient is stable enough to be transferred and understands their transfer and any associated costs that may result. Furthermore, they must sign the consent form a full 72 hours before any additional treatment for it to be considered billable non-emergency treatment.

Non-emergency medical services at an in-network healthcare facility

Patients are also protected from unexpected medical fees when out-of-network providers, like anesthesiologists, provide additional medical care in an in-network facility like a surgical center. The law considers the following as non-emergency medical services:

  • Laboratory
  • Pathology
  • Anesthesiology
  • Radiology
  • Neonatology
  • Diagnostic

Patient disclosure

Providers and healthcare facilities must provide patients with disclosures detailing their billing protections. The disclosures must also have the contact details of federal and state agencies to report any violations of the protections.

Payment disputes between insurance companies and providers

If there is a dispute or denial of payment between the insurance company and the provider, they have 30 days to negotiate it. If there is no agreement on the payment by four business days after the negotiation period, the parties must seek an independent dispute resolution.

What is Balance Billing?

You may owe out-of-pocket costs like copayments and deductibles when obtaining treatment from your healthcare provider. If you go to an out-of-network facility or provider, you may incur additional fees or be required to pay the total cost of the visit.

The difference between your plan’s agreed costs and the amount charged may be billed to you by out-of-network providers. This process is known as balance billing. The balance bill could be more expensive than you would pay for the same in-network service.

A study found that balance billing charges for anesthesia can cost over $1,200, $2,600 for surgical assistants, and $750 for childbirth.

If you receive a balance bill from an out-of-network provider, they must also send you a notice and consent form. Beware, you forgo the NSA’s billing protections if you sign the consent form and accept a balance bill.

Those who have any of the following federally sponsored health insurance coverage already have protections against balance billing and surprise bills:

  • Medicare
  • Medicaid
  • Veterans Health Services
  • Tricare
  • Indian Health Service

How the No Surprise Act Can Affect Accident Injury Victims

After an accident, you should not receive any surprise bills for emergency services or additional medical services from the attending physicians and the hospital. If you decide to schedule a medical procedure, check whether the healthcare providers and the facility you are planning to visit are in your network.

When you don’t have health insurance or plan to self-pay, the law ensures you receive a good faith estimate of how much your medical treatment costs before you agree to the procedure.

If you received a surprise bill on or after January 1, 2022 after an accident and paid more than your in-network cost, you can file a complaint with the No Surprises Help Desk.

When a Surprise Bill Arrives for Medical Treatment, Contact a Lawyer

If you are in dispute over surprise medical bills, you need a lawyer to help ensure your rights to transparency about your medical costs. The personal injury and wrongful death lawyers at Wagner Reese can help you understand the surprise billing protections under the No Surprises Act and how to dispute it. Contact our law office today for a free case evaluation.