No Surprises Act
As a member of UCare Individual & Family Plan, we want you to know your rights against surprise medical bills. If you get emergency care at an out-of-network hospital or from an out-of-network doctor in an emergency setting, you are protected from surprise billing through the No Surprises Act.
What is surprise billing or balance billing?
When you see a doctor or other health care provider, you may owe out-of-pocket costs, such as a copayment or deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network. In some cases, an out-of-network provider can bill you for the difference between the charges the provider bills, and the amount paid by your health plan. This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit. This is known as balance billing.
Surprise billing is an unexpected balance bill. You may get a surprise bill when you can’t control who is involved in your health care, such as when you have an emergency or when you schedule a visit at an in-network facility but are unknowingly treated by an out-of-network provider.
What is the No Surprises Act?
The No Surprises Act is a law establishing federal standards to help resolve surprise bills for fully insured individuals. Under the new law, beginning January 1, 2022, you will be protected from surprise bills resulting from emergency care, non-emergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers.
Under the No Surprises Act, excessive out-of-pocket costs will be restricted, and emergency services must continue to be covered without prior authorization, and regardless of whether or not a provider or facility is in-network.
The law applies to:
- Emergency services at out-of-network hospitals or other emergency facilities
- Out-of-network providers at in-network facilities
- Out-of-network air ambulance services
Who does the No Surprises Act protect?
The No Surprises Act protects individual and family plan members, as well as members of small and large group employer plans.
Minnesota balance billing statutes protect against:
- Emergency services provided at out-of-network hospitals or other emergency facilities. See 62Q.55 EMERGENCY SERVICES.
- Out-of-network services provided at in-network facilities. See 62Q.556 UNAUTHORIZED PROVIDER SERVICES.
- In-network provider discounts. See 62K.11 BALANCE BILLING PROHIBITED.
If you believe you’ve been wrongly billed, call the No Surprises Help Desk at 1-800-985-3059. For more information about your rights, visit cms.gov/nosurprises.