The No Surprises Act was enacted in 2022. The federal legislation will protect consumers from many types of surprise bills, including those received from hospitals and clinics.
What are surprise medical bills?
Otherwise known as balance billing, occurs when a healthcare provider or facility bills a patient for care after the patient's health insurance company has paid its share of the bill. The patient would have been expected to pay the difference between the provider's charge and the price the insurance company set, after the patient has paid any copays, coinsurance, or deductibles.
This would happen when a patient receives care from an out-of-network provider. In-network providers agree to accept the insurance payment in full. Out-of-network providers would bill the patient for the costs not covered by the insurance company.
Medicare and Medicaid have separate protections against balance billing.
How am I protected?
With the passage of the No Surprises Act, consumers are protected from:
- Surprise bills for most emergency services, even if those are incurred out-of-network and with prior approval.
- Out-of-network cost-sharing (out-of-network coinsurance or copayments) for most emergency and some non-emergency services. You can't be charged more than in-network cost-sharing for these services.
- Ban out-of-network charges and balance bills for certain additional services furnished by out-of-network providers as part of a patient's visit to an in-network facility.
- Require that health care providers and facilities give you an easy-to-understand notice explaining the applicable billing protections, who to contact if you have concerns that a provider or facility has violated the protections, and that patient consent is required to waive billing protections.
These protections apply to you if you hold insurance from your employer, an individual health insurance plan, or a health insurance exchange.
Can I dispute a medical bill?
If your provider charged at least $400 over your good faith estimate, you may be eligible to dispute your medical bill. An independent third party will review your bill and determine an appropriate payment. For a step-by-step guide, click here.
Don't have insurance or paying without insurance?
The new rules ensure that you receive a good faith estimate of how much your care will cost before you receive it.
If you have questions about surprise billing or receive something you are unsure of, please contact the North Dakota Insurance Department.