If You Are Uninsured

For uninsured or self-paying patients, the No Surprises Act provides rules for a good faith estimate of how much a medical service will cost. You may request an estimate if you schedule a medical service at least three business days out or simply ask for one. If your final bill is $400 or more than the estimate, you may be able to dispute it. Having a good faith estimate allows patients to make informed decisions about their care.

Independent Dispute Resolution

To resolve payment disputes between providers and insurers, the Act establishes an independent dispute resolution (IDR) process. This process allows providers and insurers to submit their proposed payment amounts to an independent arbiter who makes the final decision. The IDR process aims to protect patients from being caught in payment disputes and ensures a fair resolution for all parties involved.

Pricing Transparency

In addition to protecting patients from surprise medical bills, the Act also includes provisions to increase healthcare pricing transparency. Health insurers must provide patients with clear and detailed information about their healthcare coverage. This includes a description of providers’ network status and estimated cost-sharing amounts. This increased transparency aims to empower patients to make informed healthcare decisions and avoid unexpected charges.

The No Surprises Act is a significant step toward addressing surprise medical billing and protecting patients from financial harm. By implementing clear rules and procedures, patients are not caught off guard by unexpected charges and have access to fair dispute resolution. With the Act in place, patients can have more confidence in seeking medical care, knowing they will not face unexpected financial burdens.

Philip J. Kavesh
Nationally recognized attorney helping clients with customized estate planning guidance for over 40 years.
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