No Surprises Billing Act

No Surprises Billing Act

At Princeton Brain, Spine & Orthopedics, transparency and patient trust are at the heart of our care. We want you to feel informed and confident about your healthcare costs. The No Surprises Billing Act, a federal law effective January 1, 2022, protects patients from unexpected medical bills for certain out-of-network services.

What Is the No Surprises Billing Act?

The No Surprises Billing Act protects you from “surprise bills” – those unexpected charges that occur when you receive care from an out-of-network provider or facility without realizing it.

This law applies to:

• Emergency services (including emergency room visits and air ambulance services)
• Non-emergency services performed by out-of-network providers at in-network facilities (for example, if you see an out-of-network anesthesiologist at an in-network hospital)
• Air ambulance services from out-of-network providers

What This Means for You

You are only responsible for in-network cost-sharing amounts (such as copayments, coinsurance, and deductibles) for covered services. You cannot be billed for more than your plan’s in-network rate for these protected situations.

If you receive a bill that you believe violates these protections, you have the right to dispute it.

Your Rights and Protections

You are protected from surprise medical bills when:

• You receive emergency care from an out-of-network provider or facility.
• You receive non-emergency services at an in-network hospital or ambulatory surgical center from an out-of-network provider without giving written consent to be billed out-of-network.
• You receive air ambulance services from an out-of-network provider.

You are not required to sign any waiver or consent form to give up these protections unless you choose to receive non-emergency services from an out-of-network provider at an in-network facility.

Cost Estimate for Uninsured or Self-Pay Patients

If you are uninsured or choose to self-pay, you have the right to request a Good Faith Estimate of the expected charges before you receive care.

This estimate will include expected costs for the primary service and any related items or services that are reasonably expected to be provided.

If you receive a bill that is $400 or more than your Good Faith Estimate, you may dispute the bill.

How to Dispute a Bill

If you believe you’ve been wrongly billed, you can contact the Centers for Medicare & Medicaid Services (CMS) for help. Visit www.cms.gov/nosurprises or call 1-800-985-3059.