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No Surprises Act Balance Billing Protections
The No Surprises Act protects patients from large and unexpected surprise bills for out-of-network services and certain non-emergency services provided in in-network health care facilities. When you receive care or are treated by an out-of-network provider at an in-network healthcare facility, you are also protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance, and/or deductible.
Good Faith Estimate
Under the law, health care providers need to give patients who don’t have insurance, that are out of network, or that are choosing to not use their insurance an estimate of the bill for medical items and services. Patients may also request a good faith estimate at any time to review pricing.
Surprise Billing Protection Form
The purpose of this document is to let you know about your protections from unexpected medical bills. This form is used if you would like to give up those protections and pay more for out-of-network care.