The No Surprises Act is a critical piece of legislation designed to safeguard the rights of patients and protect them from unexpected medical bills. At Jackson Hospital, we are fully committed to adhering to the provisions of this act. Our primary goal is to ensure that our patients are not subjected to surprise bills for emergency services received at out-of-network facilities or from out-of-network providers at our in-network hospital. Instead, patients are only responsible for the cost-sharing amounts typically associated with in-network care. We also extend our support to uninsured patients by providing them with a transparent and fair estimate of the cost of their medical care.
Understanding Balance Billing and Surprise Billing
What is “balance billing” (sometimes called “surprise billing”)?
In healthcare, “balance billing” refers to the practice of billing patients for the difference between what their health insurance plan agrees to pay and the total amount charged for a service. This often occurs when patients receive care from providers or visit facilities that are not within their health plan’s network. “Surprise billing” specifically pertains to unexpected balance bills, which can happen when patients have little control over who provides their care, such as during emergencies or when they schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.
Protections Against Balance Billing
At Jackson Hospital, we prioritize patient protection against balance billing. You are safeguarded from balance billing in the following situations:
- If you have an emergency medical condition and receive emergency services from an out-of-network provider or facility, you will only be billed for your health plan’s in-network cost-sharing amount (e.g., co-payments and coinsurance).
- You cannot be balance billed for these emergency services, including any post-stabilization services, unless you provide written consent to waive these protections.
Certain Services at an In-Network Hospital or Ambulatory Surgical Center
- When you receive services at our in-network hospital or ambulatory surgical center, some providers may be out-of-network.
- In such cases, the maximum amount these providers can bill you is your health plan’s in-network cost-sharing amount.
- This protection applies to various services, including emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services.
- These out-of-network providers cannot balance bill you and are not allowed to ask you to waive your balance billing protections.
Additional Protections When Balance Billing Is Prohibited
When balance billing is not allowed, you can trust that you have the following protections at Jackson Hospital:
- You are only responsible for paying your share of the cost, which includes co-payments, coinsurance, and deductibles, similar to what you would pay if the provider or facility were in-network.
- Your health plan will directly cover out-of-network providers and facilities.
- Your health plan must cover emergency services without prior authorization and by out-of-network providers.
- Cost-sharing is determined based on in-network rates and is clearly explained in your explanation of benefits.
- Any payments you make for emergency or out-of-network services will count toward your deductible and out-of-pocket limit.
Good Faith Estimate
Patients have the right to receive a “Good Faith Estimate” explaining the expected cost of their medical care. At Jackson Hospital, we ensure that you receive this estimate for non-emergency items or services, including related costs like medical tests, prescription drugs, equipment, and hospital fees. To obtain a Good Faith Estimate, simply request it from your healthcare provider at least one business day before your medical service or item.
Jackson Hospital is dedicated to ensuring transparency and fairness in healthcare billing, in alignment with the No Surprises Act. Your well-being and peace of mind are our top priorities.