Great News for NSPC Patients: You’re Protected from Out of Network (OON) Medical Bills

Great News for NSPC Patients: You’re Protected from Out of Network (OON) Medical Bills

A new federal law (Section 2799B-3 of the Public Health Service Act) mandates that your cost for an out-of-network (OON) surgery won’t be different than what you would expect to pay for an in-network procedure.

“Out-of-network (OON)” means providers and facilities that haven’t signed a contract with your health plan to provide services to you and other patients. In the past, OON providers sent bills to patients for the difference between what the plan pays and the full amount charged for the service. This is called a “balanced bill.” These fees could be more than the in-network costs for the same service. A “Surprise Bill” is an unexpected balanced bill.

Under the new federal law, you’re only responsible for paying your share of the cost of your surgery. Your fees may include co-payments, co-insurance, and the deductible you would pay if the OON provider or facility were in-network with your health plan. Your insurance provider will pay any additional costs to OON providers and facilities directly.

Visit the Centers for Medicare & Medicaid Services website for more information: https://www.cms.gov/newsroom/fact-sheets/no-surprises-understand-your-rights-against-surprise-medical-bills