No Surprises Act
“You are not the only one who already received a bill, after a hospital visit that was hundreds, maybe even thousands of dollars more than you expected!”

What is the goal of the no surprises act? 

Starting January 2022, the goal of the “No Surprises ACT” is to protect patients from undisclosed and unexpected medical charges exceeding the in-network cost-sharing responsibilities: the deductible, coinsurance and copay.

This is particularly true when: 

• the treatments received occur out-of-network,
• there is no advance notice of the potential bills: emergency services for instance.

How is the federal government acting to protect your rights? 

By urging health providers to provide, upon the patient request or his representative, and Advanced Explanation of Benefits including the estimated costs of the services and any additional costs of procedures rendered by non-participation providers (out network providers).

Balance billing is prohibited. 

It is now forbidden for out-of-network providers rendering emergency services to balance bill patients above the applicable in-network cost sharing amount. The same requirement applies to out-of-network providers who provide non-emergency services at an in-network hospital or other facility.

The Advanced Explanation of Benefits must include: 

  • the contracted rate under the plan for the provider or service regardless of whether the provider or facility is in-network,
  • a complete description on how the patients can access information on in-network providers/facilities if the provider/facility is not in-network
  • an accurate estimation of the cost of the services to be provided, based on the billing and diagnostic codes provided:
  • the total cost for the services,
  • the amount of participant cost-sharing copay, coinsurance,
  • the accumulated amounts already met by the participant towards deductibles and out-of-pocket maximums (as of the date of the notice),
  • the amount the plan is responsible for paying.

Any questions? Contact us! 

Licensed Health Insurance Agents in Florida
French & English Speakers
jruiz@alpagos.com