The No Surprises Act (NSA) protects individuals covered under group and individual health plans from receiving surprise medical bills when they receive most emergency services, non-emergency services from out-of-network providers at in-network facilities, and services from out-of-network air ambulance service providers.

Overview of  NSA surprise/balance billing provisions

The NSA was signed into law as part of the Consolidated Appropriations Act in late 2020 and seeks to generally protect patients from surprise/balance billing for the following services:

• Out of Network Emergency Services (does not apply to ground ambulance)
• Non-emergency services furnished by out of network providers at an in-network facility
• Out of Network Air Ambulance Services

For these services, payment will be made, and in-network member out-of-pocket amounts will be based on a Qualifying Payment Amount. The Qualifying Payment Amount is a market-based median in-network rate. In the event this payment is not accepted by the provider an open negotiation period commences. If agreement cannot be reached, either party can request a binding Independent Dispute Resolution process to decide the payment amount. The provider is prohibited from billing the patient any amount other than the out-of-pocket amount specified on the explanation of benefits. This removes the patient from the process, which was the intent of the NSA.

Review the No Surprises Act (NSA) Notice.