No Surprises Act Notice

Your Rights and Protections Against Surprise Medical Bills

Effective January 1, 2022, the federal No Surprises Act protects patients from certain unexpected medical bills when receiving emergency care or certain out-of-network services.

When These Protections Apply

You are protected from surprise (also called “balance”) bills when:

  • You receive emergency care from an out-of-network provider or facility.
  • You receive care from an out-of-network provider at an in-network facility.
  • You are uninsured or self-pay and request a Good Faith Estimate for non-emergency services before receiving care.

In these situations, you generally cannot be charged more than the in-network cost-sharing amount such as copayments, coinsurance, and deductibles.

What This Means for You

If these protections apply, you cannot be balance billed for additional charges beyond your in-network cost sharing.

Your health plan will pay any additional allowed costs directly to the provider or facility.

Good Faith Estimates for Uninsured or Self-Pay Patients

If you do not have insurance or choose not to use insurance for a service, you have the right to receive a Good Faith Estimate explaining the expected cost of medical services before you schedule care.

The estimate should include expected charges for items and services related to your visit, such as tests, equipment, or other associated services.

If your final bill is at least $400 more than your Good Faith Estimate, you may have the right to dispute the bill through the federal dispute resolution process.

New Jersey State Protections

New Jersey law also provides protections against certain surprise medical bills, particularly involving emergency services or inadvertent out-of-network care at in-network facilities.

When both federal and state protections apply, the law offering the strongest patient protections will apply.

If You Think You’ve Been Wrongly Billed

If you believe you have been billed incorrectly under the No Surprises Act:

  • Review your Explanation of Benefits (EOB) from your health plan.
  • Contact your insurance company or provider for clarification.
  • You may also contact the federal No Surprises Help Desk.

No Surprises Help Desk
Phone: 1-800-985-3059
Website: https://www.cms.gov/nosurprises