No Surprises Act
Rio Grande Hospital is committed to helping you understand your upcoming health care costs so you can plan for your care. Our section on paying your bill provides several ways to pay and discuss your bill.
The federal No Surprises Act became effective Jan. 1, 2022. The law aims to help patients understand health care costs in advance of care and to minimize unforeseen — or surprise — medical bills.
No Surprises Act Overview
- Patients are protected from receiving surprise medical bills resulting from out-of-network care for emergency services and for certain scheduled services without prior patient consent.
- Patients who do not have insurance or who are not using insurance to pay for care have a right to receive a good faith estimate of their potential bill for medical services when scheduled at least three days in advance.
- Individuals with Medicare, Medicare Advantage, Medicaid, Indian Health Services, VA health care, or TRICARE insurance plans are not covered under the No Surprises Act because these federal insurance programs have existing protections in place to minimize large, unforeseen bills.
Surprise Medical Bills
Unforeseen medical bills can happen when a patient receives emergency or scheduled clinical care or services from a provider or facility that is considered out of network or non-participating by that patient’s insurance plan. These surprise bills are often called balance billing or out-of-network billing.
- Balance billing occurs when a provider sends a bill to a patient to cover the difference between what the insurance plan agreed to pay the provider and the full cost for a service. Learn more about your rights for balanced billing.
- Out-of-network costs happen when a patient receives care from a facility or provider not participating in that patient’s insurance plan. This may result in a higher patient cost than if the patient were seen by an in-network provider or facility.
The No Surprises Act will reduce instances where patients face unexpected medical bills due to receiving care from an out-of-network facility or provider during an emergency. Similarly, patients are protected from receiving surprise bills for certain scheduled services for which they could not reasonably know the network status of a provider. For certain scheduled care with out-of-network providers, patients must be given appropriate notice and give approval, where applicable, to be billed for any applicable out-of-network fee or amount.
Get a Cost of Care Estimate
Uninsured and self-pay patients have a right to receive a good faith estimate ahead of scheduled nonemergency health care services. A good faith estimate shows the cost of items and services that are reasonably expected for your health care needs. The estimate is based on information known at the time the estimate was created, and can include costs related to your visit such as medical tests, medications, equipment and hospital fees.
Health care providers should give you the estimate in writing at least one day before your medical service if your care has been scheduled at least three days in advance. You may also request an estimate at any time.
If you have questions related to receiving a good faith estimate, call 719-657-4122.
For details about the law, visit the No Surprises Act site from the Centers for Medicare and Medicaid Services.