November 30, 2024

The No Surprises Act of 2022 protects out-of-network patients from “surprise” bills from healthcare providers. Surprise bills are those that contain higher fees health insurance plans can charge when services are delivered by out-of-network providers rather than in-network providers (who have agreed to the prices negotiated by the insurer).

Under the law, health care providers are prohibited from billing out-of-network patients for more than their in-network co-payment, co-insurance, or deductible without the patients written consent. If patients do receive a bill for these services, they have the right to challenge the charges.

To save the hassle and fend off fee challenges, healthcare providers should make sure to provide all out-of-network patients with a good faith estimate of the charges they can expect to pay, and to obtain their informed consent to the proposed treatment and fees. If a patient refuses to give consent, providers can ask that they seek treatment elsewhere (except in certain emergency situations). Uninsured patient, who pay for services out-of-pocket, are also entitled to a good faith estimate of fees.

Additionally, the Act requires providers to post a disclosure notice informing patient of their protections from surprise bills at their offices and on their public website. This notice must also be given to patients when seeking payment, whether from the patient or their health plan.

If you treat out-of-network or uninsured patients, save time, money, and stress by adding these simple steps to your intake process.

Questions or comments? Please contact us at (646) 213-9044 or Admin@AndrieuxLaw.com.