Protections Against Surprise Medical Bills (No Surprises Act)

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The No Surprises Act, which took effect on Jan. 1, 2022, provides patients with financial protections against surprise medical bills and prohibits balance billing for certain out-of-network care.

Surprise Billing Protection Form

Stanford Medicine Children’s Health will provide patients who have a scheduled appointment and an out-of-network provider at an in-network facility a Surprise Billing Protection Form. This form contains a Good Faith Estimate of charges for the service requested and a clear statement that consent is optional; by signing the form, the patient agrees to pay more for out-of-network care.

Consumer Protection Disclosure

In addition, Stanford Medicine Children’s Health will provide patients a Consumer Protection Disclosure that includes information in clear and understandable language; it explains the following:

  1. When there are bans on balance billing.
  2. Any state laws that protect you from balance billing.
  3. What state or federal agency to contact if you think your provider or hospital has not followed the bans on balance billing.
  4. Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate (“Good Faith Estimate”) of the bill for medical items and services.

Consumer Protection Disclosure >

Right to receive a Good Faith Estimate >

To learn more about the No Surprises Act, visit HHS Announces Rule to Protect Consumers from Surprise Medical Bills | CMS >

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a 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. “Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit. “Surprise billing” is an unexpected balance bill. This can happen when you can’t control who provides your care. Emergency care and being treated by an out-of-network provider at an in-network clinic are examples of when they may occur.

No. Out-of-pocket costs of copays, deductibles, and coinsurance are part of the benefit design with your health coverage, and you are expected to pay these amounts up to the out-of-pocket maximum limit defined by your coverage. Note that in-network benefits can differ significantly from out-of-network benefits. You may have higher out-of-pocket costs if your coverage is considered out-of-network at Stanford Children’s Health or its affiliates.

No. But you will likely pay higher out-of-pocket costs when seeing an out-of-network provider.

You can contact our Financial Counseling Team at (650) 736-2276 (CARE).