No Surprises Act: Protecting Client Rights

Effective January 1, 2022, the No Surprises Act, passed by Congress as part of the Consolidated Appropriations Act of 2021, aims to protect client rights by preventing surprise billing for emergency services provided at out-of-network facilities or for out-of-network providers at in-network facilities. This law ensures that clients are only responsible for in-network cost-sharing amounts, significantly reducing unexpected health care costs. Additionally, the No Surprises Act allows uninsured clients to receive a good faith estimate of their care costs.

Overview

Surprise billing occurs when clients receive care from out-of-network providers without prior knowledge, leading to higher medical expenses that could have been avoided had the services been rendered by in-network providers. This situation can arise if any provider involved in the client's care is not within their health plan’s network. The No Surprises Act is designed to minimize these unexpected costs and to prohibit out-of-network charges without prior notice, ensuring clients receive a clear consumer notice.

Consumer Notice

A key component of the No Surprises Act is the requirement for out-of-network providers to inform potential clients that they are outside the client’s health plan’s network. Clients can also waive their right to avoid out-of-network charges for non-emergency services if they provide consent.

We have a standard notice available for out-of-network clients seeking services, which must be delivered within seventy hours of the scheduled appointment or service (or within three hours for same-day services). Upon request, we can provide this notice in either paper or electronic format, and you will receive a copy. The notice will clearly state:

- The provider (or our facility) is out-of-network;

- An estimate of the cost of our services, calculated in good faith.

This document will be distinct from other paperwork you sign prior to receiving care and can be provided in additional languages if requested.

You are never required to give up your protections regarding surprise billing, nor are you obligated to obtain out-of-network care. You have the freedom to choose a provider or facility within your plan’s network.

Lastly, there is a stipulation that out-of-network providers must notify health plans when they provide client services and must certify that they have fulfilled the necessary notice and consent requirements. We will maintain these records for a minimum of seven years.

If You Think You Have Been Wrongly Billed or Have More Questions

If you believe you have been subjected to surprise billing or are unsure whether the No Surprises Act applies to your situation, or if you have any additional questions about standard notice forms or the Act itself, please reach out to us for assistance.

Complaints

If you still feel you have been wrongly billed, you can direct complaints to the Centers for Medicare & Medicaid Services (CMS) at https://www.cms.gov/nosurprises/consumers or call 800- 985-3059.