The No Surprises Act applies to health insurance plans starting in 2022. It applies to the self-insured health plans that employers offer as well as plans from health insurance companies. The No Surprises Act protects you from:
- Surprise bills for covered emergency out-of-network services, including air ambulance services (but not ground ambulance services), and
- Surprise bills for covered non-emergency services at an in-network facility.
- A facility (such as a hospital or freestanding emergency room) or a provider (such as a doctor) may not bill you more than your in-network coinsurance, copays, ordeductibles for emergency services, even if the facility or provider is out-of-network.
- When you receive non-emergency services from out-of-network providers (such as an anesthesiologist) at in-network facilities, an out-of-network provider may not bill you more than your in-network copays, coinsurance, or deductibles for covered services performed at an in-network facility.
- You can never be asked to waive your protections and agree to pay more for out-of-network care at an in-network facility for care related to emergency medicine, anesthesiology, pathology, radiology, or neonatology—or for services provided by assistant surgeons, hospitalists (doctors who focus on care of hospitalized patients), and intensivists (doctors who care for patients needing intensive care), or for diagnostic services including radiology and lab services.
If your health plan requires you to pay copays, coinsurance, and/or deductibles for in-network care, you’re responsible for those.
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 copays.