By Rodney Davis, CEO BBB serving southeast Florida and the Caribbean

According to the Consumer Financial Protection Bureau, effective January 1, 2022, the No Surprises Act (NSA) protects you from surprise billing if you have a group health plan or group or individual health insurance coverage, and bans:

• Surprise bills for emergency services from an out-of-network provider or facility and without prior authorization
• Out-of-network cost-sharing, like out-of-network coinsurance or copayments, for all emergency and some non-emergency services
• Out-of-network charges and balance bills for supplemental care, like radiology or anesthesiology, by out-of-network providers that work at an in-network facility

The No Surprises Act also requires some health care facilities and providers to disclose Federal and State patient protections against balance billing and sets forth complaint processes with respect to violations of the protections against balance billing and out-of-network cost sharing.

To avoid surprise bills, whenever possible, work with your insurance provider to stay within your plan for doctors and other facilities for planned procedures. Do not sign documents that might waive your rights. The facility may decide not to provide services to you, but you may explore other options to avoid being responsible for bills beyond your routine insurance coverage. The No Surprise Act also provides protection for emergency surgery bills. 

If you are still billed for doctors or services from out of network providers, despite using an in-plan doctor, hospital, facility, etc., you should discuss the bill with your insurance provider. Your provider may be able to resolve the issue so that you are only billed for your customer copay or deductible consistent with your in-plan fees. 

If you are unable to resolve a bill working with your insurance provider, you may seek assistance from the Insurance Consumer Helpline in Florida (877-693-5236). You may also file a complaint at: myfloridacfo.com/division/consumers/needourhelp

The federal government also operates the No Surprises Help Desk from 8 a.m. to 8 p.m. ET, 7 days a week at 800-985-3059. They also accept online complaints at:  idm.cms.gov. You will need to create an ID and login to start the complaint process. 

The Consumer Financial Protection Bureau site provides other information and resources to assist you if you believe you are being unfairly billed.  consumerfinance.gov/ask-cfpb/what-is-a-surprise-medical-bill-and-what-should-i-know-about-the-no-surprises-act-en-2123/provides

There are also advocates to assist consumers needing assistance with bills and coverage issues. You may consult with www.bbb.org/us/fl/boca-raton/profile/health-advocate/human-health-advocates-llc-0633-90312971 or another service provider so that you are billed fairly and consistent with applicable law.