No Surprises Act and Balance Billing

No Surprises Act Statement

The No Surprises Act aims to protect consumers from unexpected medical bills, especially in situations where they receive care from out-of-network providers. Here is a summary:

Out-of-Network Emergency Care: If you need emergency medical care, you won't be charged extra for going to an out-of-network hospital or emergency room.

Surprise Medical Bills: If you receive care from an out-of-network provider at an in-network facility, you are protected from any surprise bills. You'll only be responsible for you in-network cost-sharing amount.

Advance Notice of Network Status: Before scheduling your care, providers must inform you of estimated out-of-pocket costs and whether or not they are in-network with your health plan.

Dispute Resolution: If there's a billing dispute between your health plan and a provider, an independent dispute resolution process will be used to settle the matter, keeping you out of the middle.

WA State Balance Billing Laws

Washington state also has laws protecting from balance billing, which is when you are charged the difference between what your insurance pays and the provider's total billable. Here is a summary:

Emergency Services: If you receive emergency services, you should only be responsible for your in-network cost-sharing, regardless of whether the provider is in-network or not.

Notice of Network Status: Similar to the No Surprises Act, providers must inform you of their network status before scheduled care and provide cost estimates.

Good Faith Estimates: Providers must give you a good faith estimate of the cost of non-emergency services, including any facility or professional fees.

Limit on Balance Billing: In certain situations, providers are limited in how much they can bill you for out-of-network services. You won't be responsible for amounts beyond what your in-network cost-sharing would be in these specific situations.