The No Surprises Act takes effect on January 1, 2022 and provides patients financial protections against surprise medical bills, and prohibits balance billing for certain out-of-network (OON) care.
Individuals with Medicare, Medicare Advantage, Medicaid/MediCal, Indian Health Services, VA health care, or TRICARE insurance plans are not covered under the No Surprises Act because these federal insurance programs have existing protections in place to minimize large, unforeseen bills.
Frequently Asked Questions
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 or 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 Health Care 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 teams. For Stanford Health Care, please call 650-498-2900 (select option 2, then option 5). For Stanford Health Care Tri-Valley, please call 925-534-6692. For University Healthcare Alliance (UHA), please call 925-263-5500 and ask for Financial Counseling.
If you receive a bill that is more than $400 compared to your Good Faith Estimate, you can contact our Customer Service Billing department at 800-549-3720 to dispute the bill. For more information regarding the dispute process, please review: Right to Receive a Good Faith Estimate for Self-Pay or Uninsured Patients »
Surprise Billing Protection Form
Stanford Health Care will provide patients with 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, a clear statement that consent is optional, and by signing the form, the patient agrees to pay more for out-of-network care.
Consumer Protection Disclosure
In addition, Stanford Health Care will provide patients with a Consumer Protection Disclosure that includes information in clear and understandable language which explains:
- When there are bans on balance billing
- Any state laws that protect you from balance billing
- What state or federal agency to contact if you think your provider or hospital has not followed the bans on balance billing
- 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 for Self-Pay or Uninsured Patients »
To learn more about the No Surprises Act, visit HHS Announces Rule to Protect Consumers from Surprise Medical Bills | CMS »
Patient Rights and Protections
Protections Against Surprise Medical Bills (No Surprises Act)
Access More From MyHealth (CURES Act)