On January 1, 2022, Hartford HealthCare implemented the No Surprises Act (NSA), a law designed to protect patients against unexpected bills.
The law requires healthcare providers to provide good faith cost estimates to uninsured and self-pay patients before services are rendered; prohibits out-of-network providers and healthcare facilities from “balance billing,” or billing the difference between allowed charges and provider charges without notice and consent; and clearly outlines the complaint and dispute resolution processes.
Frequently Asked Questions
When did this start?
January 1, 2022
What is it?
The federal No Surprises Act (NSA) was designed to:
- Protect patients against practices called “surprise medical billing,” “balance billing” and “cost sharing” for certain out-of network services.
- A surprise medical bill is one sent to a patient with insurance who doesn’t know they received medical services from one or more healthcare providers who are “out-of-network,” or who do not participate with the patient’s insurance. This usually happens when the patient cannot choose an in-network provider or when an out-of-network provider gets involved in their in-network care.
- Surprise medical bills have two parts: the difference in the patient’s financial responsibility between in-network and out-of-network providers, and the difference between charges that are allowed, such as discounted charges negotiated by providers and insurance companies, and the provider’s full charge.
- Patients can receive surprise medical bills for emergency and non-emergency services. In an emergency, people usually seek care at the nearest emergency department. But, even if they go to an in-network hospital, they might get care from a non-participating provider. This new law also protects patients who go to a non-participating emergency department.
- For non-emergency care, people might choose an in-network provider, not knowing that another provider involved in their care - such as an anesthesiologist or radiologist - is out-of-network.
- Balance Billing is considered billing a patient the difference between allowed charges (i.e., discounted charges negotiated by providers and insurance companies) and the provider’s full charge.
- Keep non-participating providers and healthcare facilities from balance billing patients under specific circumstances without letting them know and getting their consent.
- Require providers to give any uninsured or self-pay patients a good faith estimate for care before it is given.
- Require providers to tell patients about all federal and state patient protections against balance billing.
- Describe how patients, payers and providers can address any potential violations.
Who does the No Surprises Act protect?
- Patients who have health insurance/coverage (including Federal Employee Health Benefits Plans or FEHBPs), who receive emergency services, EXCEPT:
- If the patient consents to certain post-stabilization services, such as an out-of-network patient traveling a reasonable distance using nonemergency medical transportation to an in-network provider or facility.
- Patients who have health insurance/coverage (including FEHBPs) who receive non-emergency services from non-participating providers in participating facilities, EXCEPT:
- When notice and consent is received within a specific time before services are given. For example, 72 hours in advance, the same day if the appointment was made within 72 hours, or, if the appointment was made the same day, three hours before.
- Patients who have health insurance/coverage (including FEHBPs) who receive air ambulance services from non-participating providers.
- Uninsured patients, or insured patients who decide to pay out-of-pocket instead of billing their insurance. They are required to receive a good faith estimate at the time of scheduling services.
- Disclosure Regarding Rights and Protections Against Surprise Medical Bills
What is a “good faith estimate?”
Patients who do not have health insurance or are not using their insurance to pay for their healthcare are entitled to a “good faith estimate” of the expected cost of any non-emergency items or services. These must be given in writing at least one business day before medical services are given, unless the appointment is scheduled less than three days in advance. Patients can also ask a healthcare provider for a “good faith estimate” before scheduling an item or service.
If a bill is at least $400 more than the good faith estimate, patients can dispute it through the U.S. Department of Health & Human Services. There is a fee to dispute bills.
Who is NOT affected by these “surprise billing” rules?
- Patients whose insurance isn’t accepted by the facility at all, but who choose to schedule or receive non-emergency care here.
- Patients whose entire non-emergency visit is in-network, meaning the facility and treating providers participate in their insurance coverage.