In a health emergency, it’s not always possible to get all in-network care. Even with scheduled care, you may not know when a service (a lab test, for example) is out-of-network.The federal No Surprises Act aims to reduce surprise medical bills and help you understand your health care costs before you get care.
What is a Surprise Medical Bill?
If you have health insurance and get care out-of-network, your health plan may not cover the entire amount. This can result in a higher cost than if you used an in-network provider or facility. Until recently, you could be billed for the difference between the amount billed and what your health plan paid. This is called “balance billing” or a surprise medical bill.
What are the new protections if I have health insurance?
If you have health coverage through your employer, the Health Insurance Marketplace®, or an individual health insurance plan, these new rules will:
- Protect you from surprise bills for emergency services, even if you get them out-of-network and without prior authorization.
- Protect you from out-of-network cost-sharing (like coinsurance or copayments) for all emergency and some non-emergency services. You can’t be charged more than in-network cost-sharing for these services.
- Protect you from out-of-network charges and balance bills for supplemental care (like anesthesiology or radiology) by out-of-network providers who work at an in-network facility.
- Require health care providers and facilities to give you an easy-to-understand notice explaining that out-of-network care could be more expensive. It will also give options to avoid balance bills. You are not required to sign this notice or get care out-of-network.
What if I don’t have health insurance or choose to pay for care on my own?
If you are uninsured or you choose to pay for care without using your insurance, these new rules make sure you can get a “good faith estimate" of your bill, before you get care.
If you are a QualChoice member and you have questions about your bill or believe you’ve been wrongly billed, please call us at 501.228.7111 or 800.235.7111 (TTY: 711).
