No Surprises Act Quiz
The No Surprises Act is a brand new federal regulation that establishes protections from sudden payments for customers with personal medical insurance.
Take a look at your understanding of the regulation and share your outcomes!
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The No Surprises Act protects you by limiting what you have to pay for certain types of medical bills. Of the types of bills listed below, which one is not subject to No Surprises Act Protections?
The No Surprises Act limits what privately insured patients have to pay for covered services that they inadvertently receive from providers that are out-of-network. The law applies to emergency services, to non-emergency services provided in in-network hospitals and facilities, and to air ambulance services.
Under federal law, the most privately insured patients can be asked to pay for an out-of-network surprise medical bill is
The law requires that private health plans cover surprise medical bills and apply in-network cost sharing. Out-of-network providers are prohibited from billing patients for more than the in-network cost sharing amount for a surprise medical bill.
The No Surprises Act prohibits “balance billing” for surprise medical bills. Balance billing by an out-of-network doctor or hospital means
When out-of-network providers charge a patient the difference between their full charge and the “allowed amount” for a service that the patient’s health plan considers reasonable, that difference is called balance billing.
True or false, under federal law, consumers are now protected from balance billing for out-of-network emergency services, including ground and air ambulance transport.
Ground ambulance services are not covered yet under federal law, though state surprise medical bill laws do apply to ground ambulance services in some states.
Regulations implementing the No Surprises Act permit health plans to deny coverage for emergency services in which of the following special circumstances:
Insurance coverage for emergency care must be based on a “prudent layperson” standard that considers symptoms but not a final diagnosis. Plans cannot require pre-authorization of emergency care nor deny coverage based on the time it took to seek care or because, after medical examination, the condition was found to not be a medical emergency.
Consider this scenario: You had cancer surgery at an in-network hospital. Tumor tissue was sent to a laboratory outside of the hospital for analysis. The pathologist who examined the tissue does not participate in your health plan network and bills independently from both the laboratory and the hospital. Do federal surprise medical bill protections apply to the pathologist’s fee?
Under the regulations, the in-network hospital “visit” includes items and services furnished as part of that visit, regardless of whether the provider furnishing such service is physically at the facility.
Consider this scenario: You have surgery at a hospital that participates in your health plan network, but the anesthesiologist is not in your network. Under the No Surprises Act, what is the anesthesiologist permitted to do?
The No Surprises Act prohibits out-of-network providers from billing patients for more than the amount of cost sharing (deductible, copay, etc.) that would have applied had the care been provided by an in-network provider, or face fines as high as $10,000 per violation.
If you get a bill directly from an out-of-network provider for emergency care, how can you tell if that bill is appropriate under the No Surprises Act?
The No Surprises Act prohibits out-of-network providers from billing insured patients for more than the in-network cost sharing amount that would otherwise apply. The insurance statement (EOB) should also reflect that amount. Providers are also required to give patients written notice of their surprise billing protections, though notice does not have to be included with the actual bill.
Which answer best describes responsibilities that apply to private health plans under the No Surprises Act?
Plans must cover surprise medical bills and apply in-network cost sharing. The plan statement, or EOB, should show the in-network cost sharing amount patients are responsible for and include a notice summarizing No Surprises Protection. Plans must also tell the out-of-network provider the patient’s in-network cost sharing amount for a surprise bill.
True or false: If a health plan refuses to cover an out-of-network service provided at in an in-network hospital, consumers have the right to appeal, and State Consumer Assistance Programs can help people file appeals.
The No Surprises Act requires that consumers have the right to appeal disputes with health plans over whether a bill is subject to the No Surprises Act, including the right to external appeal. Plan denial notices must provide contact information for state Consumer Assistance Programs (CAPs) that can help consumers file appeals.
Under the No Surprises Act, certain out-of-network providers can ask patients in advance to waive their surprise medical bill protections, but the law specifies that certain types of providers are never allowed to ask patients for consent to waive their federal surprise billing rights. Which of the providers below are permitted to ask patients in advance to waive their federal protections?
Patients can be asked in advance by some out-of-network providers, including surgeons, to waive their balance billing protections for non-emergency services provided at in-network hospitals. The other providers listed in this question are not allowed to ask consumers to waive their No Surprises Act protections.
The No Surprises Act establishes a new independent dispute resolution (IDR) process to determine the amount paid for surprise medical bills when out-of-network providers or facilities and health plans cannot reach agreement on their own. What do patients have to do as part of this IDR process?
The IDR process is between the health plan and the out-of-network provider or facility. Once the patient pays the in-network cost sharing amount for a surprise medical bill, they have no further responsibility.