**The Uninsured Er Visit: When Billing Insurance Isn't An Option**

In the United States, the No Surprises Act (NSA) protects insured patients from unexpected out-of-network medical bills for emergency room visits. This means that, in most cases, patients are protected from surprise bills for emergency medical services. The Act also applies to non-emergency care related to a visit to an in-network hospital, hospital outpatient department, or ambulatory surgical centre, as well as air ambulance services. However, ground ambulance services are generally not covered by the NSA and can still result in out-of-network charges. If a patient does not have insurance, providers are usually required to give a good faith estimate of the cost of care if requested or scheduled in advance. State laws may also offer additional protections, such as banning surprise bills from ground ambulance services for those with state-regulated plans.

The No Surprises Act protects against unexpected out-of-network charges for emergency services

The No Surprises Act (NSA) is a federal law that came into effect on January 1, 2022, to protect people from unexpected medical bills. It applies to most types of health insurance and protects against unexpected out-of-network charges for emergency services.

The Act defines an emergency as a medical condition manifesting itself by acute symptoms of sufficient severity, including severe pain, such that the absence of immediate medical attention could reasonably be expected to result in placing the patient's health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.

Under the NSA, if you have health insurance, you are protected from surprise billing for emergency services, even if you receive them out-of-network and without prior authorization. This means that you cannot be charged more than the in-network cost-sharing amount for these services. The Act also bans out-of-network charges and balance bills for certain additional services, such as anesthesiology or radiology, provided by out-of-network providers as part of a patient's visit to an in-network facility.

In addition, the NSA establishes an independent dispute resolution process for payment disputes between plans and providers and provides new dispute resolution opportunities for uninsured and self-pay individuals when they receive a medical bill that is significantly higher than the good faith estimate they received from the provider.

If you don't have health insurance or choose not to use it for a particular service, the NSA ensures that you will usually get a good faith estimate of how much your care will cost before receiving it. If the final charges are at least $400 more than the good faith estimate, you may be able to dispute the bill.

It's important to note that ground ambulance services are generally not covered by the billing protections in the NSA and may still result in out-of-network charges.

If uninsured, providers must give a good faith estimate of costs if requested or scheduled 3 days in advance

The No Surprises Act, which came into effect on January 1, 2022, is a federal law that protects patients from unexpected out-of-network medical bills. This includes emergency room visits, non-emergency care related to a visit to an in-network hospital, hospital outpatient departments, ambulatory surgical centres, and air ambulance services.

If you are uninsured, the Act requires that your health care provider must give you a good faith estimate of expected charges if you request one or schedule services at least three business days in advance. This estimate should include expected charges for the scheduled healthcare items and services, such as facilities fees, hospital fees, and room and board provided by the provider or facility. It should be noted that good faith estimates only list expected charges for a single provider or facility, and you may need to request estimates from multiple providers.

The good faith estimate is not a perfect estimate but should account for foreseeable charges. It should include the patient's date of birth, an itemized list of items or services involved in the treatment, the name of each provider/facility involved in the treatment, and various disclaimers. This information should be provided in writing, either electronically or on paper, in a language understandable to a layperson.

If you are uninsured, you have the right to receive a good faith estimate of the amount you will be billed for scheduled or non-emergency items or services. You are entitled to receive this estimate in writing at least one business day before your scheduled medical service. You can also request an estimate from your healthcare provider before scheduling a service. If the total charges billed to an uninsured patient are significantly higher than the good faith estimate, the patient has the right to initiate a dispute resolution process within 120 calendar days of receiving the initial bill.

You can dispute a bill if it's $400 more than the estimate

If you receive a medical bill that is $400 or more than the estimate you were given, you may be able to dispute it. This process is known as "patient-provider dispute resolution" (PPDR). When you dispute a bill, an independent third party will review it and determine an appropriate payment.

To be eligible to start a dispute, the following criteria must be met:

• You did not have or did not use your health insurance to pay for the care.
• You informed your provider that you weren't using insurance to pay for it before receiving care.
• You received care on or after January 1, 2022.
• You have a good faith estimate from your healthcare provider or facility.
• You have an initial bill dated within the last 120 calendar days (about 4 months).
• One of your providers or facilities charged at least $400 more than their good faith estimate.

To initiate the dispute process, you must pay a $25 non-refundable administrative fee. If the dispute is decided in your favour, this amount will be deducted from what you owe your provider. During the dispute, your provider or facility cannot move your bill into collections or threaten to do so. They also cannot collect any existing late fees on unpaid bills until the dispute process ends.

If you are facing difficulties paying your medical bill, there may be financial assistance or "charity care" programs that you are eligible for. These programs provide free or discounted healthcare to people who need help paying their medical bills. Additionally, you can try negotiating the bill down to an amount that you can afford or request an interest-free repayment plan.

You can apply for financial assistance if you have low to moderate income or can't afford to pay

If you have low to moderate income or can't afford to pay for your medical care, you may be eligible for financial assistance. Here are some steps you can take to seek financial help:

Check Your Eligibility

Before applying for financial assistance, it is important to determine whether you meet the eligibility criteria. Nonprofit hospitals are required to provide financial assistance to eligible patients who cannot afford to pay. Your income, age, employment status, and health insurance coverage will be key factors in determining your eligibility. Some programs have specific income thresholds, such as the Financial Assistance Policy of Texas Health, which offers assistance to individuals with an income less than or equal to 250% of the federal poverty guidelines.

Ask for a Copy of the Financial Assistance Policy

Hospitals are required by law to have a written Financial Assistance Policy (FAP) that outlines eligibility criteria and the application process. Ask the hospital for a copy of their FAP, which should be provided free of charge. You can also search for the hospital's name and "financial assistance" online to find their policy.

Gather Necessary Information

To apply for financial assistance, you will typically need to provide information about your income and expenses. This may include documents such as tax forms, pay stubs, rent or mortgage payments, utility bills, credit card statements, and other relevant expenses.

Submit Your Application

Follow the instructions provided in the hospital's Financial Assistance Policy to submit your application. They may ask you to submit a form online or print and mail it. Make sure to meet any deadlines for applying and provide all the required information.

Check the Status of Your Application

After submitting your application, stay in communication with the hospital to check the status of your application. Ask them how long the processing time is, how to get answers to any questions, and what will happen with your bill in the meantime.

Notify Debt Collectors

If your bill has already been sent to a collection agency, don't worry. You can still apply for financial assistance. Notify the debt collectors that you are seeking financial assistance and request them to pause collections while your application is pending.

Explore Other Options

If financial assistance is not available or you still need additional help, there are other options you can consider. You can reach out to patient advocate organizations or request a lower bill. Hospitals and medical offices may sometimes be able to lower the price or offer payment plans. You can also explore government programs, such as Medicare, Medicaid, the Affordable Care Act (ACA), or Children's Health Insurance Program (CHIP), which can provide additional support.

If you're insured, the No Surprises Act bans out-of-network charges for emergency services

The No Surprises Act (NSA) is a federal law that came into effect on January 1, 2022, to protect people from unexpected medical bills. It applies to most types of health insurance and prevents surprise billing for emergency services, even if they are out-of-network and without prior authorization.

The Act defines emergency services as including post-stabilization services provided in a hospital following an emergency visit. This means that if you are admitted to the hospital after an emergency room visit, you are still protected from surprise billing until a physician determines that you can be safely transferred to another in-network facility.

Under the NSA, you are also protected from surprise bills when you receive non-emergency services from an out-of-network provider at an in-network facility. This includes situations where you are referred to an out-of-network provider by your in-network doctor, or when you receive services from an out-of-network provider that works at an in-network facility, such as an anesthesiologist or radiologist.

The NSA establishes an independent dispute resolution process for payment disputes between health plans and providers. It also provides new dispute resolution opportunities for uninsured and self-pay individuals when they receive a medical bill that is significantly higher than the good faith estimate they received from the provider.

If you are insured, the NSA bans out-of-network charges for emergency services. This means that you cannot be charged more than your in-network cost-sharing amount (such as coinsurance or copayments) for these services. If you receive a surprise bill that you believe is not allowed under the NSA, you can file an appeal with your insurance company or request an external review of the company's decision.

In addition to federal protections, some states have their own surprise billing laws that provide additional protections for consumers. For example, in Colorado, consumers are protected from surprise medical bills under both state and federal law.

It is important to note that ground ambulance services are generally not covered by the NSA and you may still receive surprise bills for these services unless prohibited by state law.

Frequently asked questions