Surprise Balance Billing Protections Under the No Surprises Act
Starting January 1, 2022, people insured through their employer health plan or through a private health insurance policy have new protection from surprise balance bills.
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A surprise bill is when a person, through no fault of their own, unknowingly or unavoidably receives health care services from providers outside their insurance company's network and then is billed directly for that care.
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The No Surprises Act applies to healthcare providers, healthcare facilities, and air ambulance providers.
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The No Surprises Act does not apply to ground ambulances.
The most important resource for policyholders, insurers, and healthcare providers (including air ambulance providers) is CMS No Surprises page. The page is the home for federal resources because the No Surprises Act is a federal law; the federal resources and guidance should be a starting point for any questions.
Contact Information for Complaints
When healthcare providers, insurers, and employer health plans are completing a form or notice that is required under the No Surprises Act, the government contact information to include for complaints about a healthcare provider, air ambulance, or insurer is:
Nebraska Department of Insurance
Attn: Insurance Complaints
P.O. Box 95087
Lincoln, NE 68509-5087
Email: doi.insurancecomplaints@nebraska.gov
Subject: No Surprises Complaint
CMS Web Pages for Fact Sheets, Guidance, and Technical Resources
State/Federal Enforcement Collaboration
The Nebraska Department of Insurance (NDOI) will enter a Collaborative Enforcement Agreement with federal agencies to enforce the No Surprises Act. As part of this agreement, the NDOI will be the initial point of contact for complaints about No Surprises Act noncompliance. The NDOI will then determine whether it appears the healthcare provider, air ambulance service, or health insurer is out of compliance. The NDOI will then undertake an initial attempt to gain voluntary compliance. If the healthcare provider or air ambulance continues to pursue payment from the insured patient, or if the matter will be referred to the federal government for prosecution.
In addition to the federal No Surprises Act, Nebraska statutes include a protection from balance billing in emergency situations. The Out-Of-Network Emergency Medical Care Act, Neb. Rev. Stat. § § 44-6834 to 44-6850.
For Healthcare Providers
List of certified independent dispute resolution entities
The Department of Health and Human Services, the Department of Labor, and the Department of Treasury have certified these organizations to serve as independent dispute resolution entities in the federal independent dispute resolution process between providers, facilities, or providers of air ambulance services and group health plans, health insurance issuers, and Federal Employees Health Benefits program carriers. The Departments are continuing to receive and review applications and will update this list with additional independent dispute resolution entities as they are certified, you can access the list at https://www.cms.gov/nosurprises/Help-resolve-payment-disputes/certified-IDRE-list.
Qualifying Payment Amount (QPA) Calculation Methodology
The QPA is the basis for determining individual cost sharing for items and services covered by the No Surprises Act under certain circumstances.
Frequently Asked Questions
These FAQs were prepared by the Department of Health and Human Services (HHS) to address the provision of the Federal Independent Dispute Resolution system and Notice of Consent requirements.
These FAQs were prepared by the Department of Health and Human Services (HHS) to address the provision of GFEs for uninsured (or self-pay) individuals, as described in Public Health Services Act (PHS Act) section 2799B-6 and implementing regulations at 45 CFR 149.610.
CAA Enforcement Letters
The letters on the page below capture CMS's understanding of the PHS Act provisions, as extended or added by the CAA, that each state is enforcing either directly or through a collaborative enforcement agreement, and the provisions that CMS will enforce. These letters also communicate whether the federal independent dispute resolution process and the federal patient-provider dispute resolution process apply in each state, and in what circumstances. Additional letters will be added to this page in the coming weeks.
Uninsured or Self-Pay Resources
The federal government will be directly enforcing the No Surprises Act for people who are uninsured or self-pay. If the NDOI receives a complaint from an uninsured or self-pay policyholder, the complaint will be routed to CMS for investigation.
Patient-Provider Dispute Resolution Guidance
These guidance documents provide additional details on the Good Faith Estimate (GFE) and Patient-Provider Dispute Resolution (PPDR) process for uninsured/self-pay policyholder, provider facilities, and Selected Dispute Resolution Entities. The guidance also provides Calender Year 2022 information on the PPDR administrative fee.
