No Surprises Act: What It Means for You

Audience: all

The No Surprises Act is a law designed to protect patients from unexpected medical bills, especially when they receive care without knowing the full cost in advance. It aims to make healthcare costs clearer and prevent surprise charges from out-of-network providers. This guide explains what the Act means for you, how it affects your healthcare bills, and what to expect when using telemedicine services. Understanding your rights can help you avoid unexpected costs and make informed decisions about your care. While the Act improves transparency, it’s important to know that telemedicine visits may have different billing rules depending on your provider and insurance. Knowing your coverage and asking questions before care can help you avoid surprises.

Red flags — go in person / ER

• Receiving a medical bill much higher than expected after an emergency or telemedicine visit — contact your insurer immediately to dispute.
• Being asked to pay out-of-network fees without prior notice or consent — do not pay before verifying your rights.
• Sudden denial of coverage for a telemedicine service you were told was covered — seek help from a patient advocate or health authority.

What telemedicine can do

• Providing consultations for common health concerns.
• Offering follow-up visits and medication management.
• Giving advice on managing chronic conditions.

What telemedicine cannot do

• Performing emergency medical procedures.
• Conducting physical exams requiring hands-on assessment.
• Providing certain diagnostic tests that require in-person visits.

What Is the No Surprises Act?

The No Surprises Act is a law that helps protect patients from surprise medical bills. These bills often happen when you get care from providers who are not in your insurance network, especially in emergencies or when you don't choose your provider. The Act requires providers and insurers to be more transparent about costs and limits the amount you have to pay in these situations.

How Does It Affect Your Medical Bills?

Under this Act, if you receive emergency care or certain non-emergency services from out-of-network providers, you typically pay only your usual in-network cost-sharing amount. The law also restricts providers from charging you more than this amount without your consent. This helps prevent unexpected bills after care.

What Does This Mean for Telemedicine?

Telemedicine allows you to consult healthcare providers remotely. The No Surprises Act applies to telemedicine services, but billing rules may vary. Some telemedicine visits might be covered like in-network care, while others might not. It's important to check with your provider and insurer about costs before your tele-visit.

How to Protect Yourself from Surprise Bills

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When to Seek Help

If you receive a medical bill that you did not expect, especially after emergency care or telemedicine visits, review it carefully. You can dispute charges that seem incorrect or contact your insurer for assistance. Many regions have agencies or hotlines to help with surprise billing issues.

How to prepare for your tele-visit

• Check if your telemedicine provider is in your insurance network.
• Verify what telemedicine services your insurance covers.
• Prepare a list of your symptoms and medical history.
• Ensure you have a reliable internet connection and a private space for your visit.
• Have your insurance information and any previous medical records ready.

After your tele-visit

• Review any instructions or prescriptions given during the tele-visit.
• Monitor your symptoms and follow up if they worsen or do not improve.
• Keep records of your telemedicine visit and any bills received.
• Contact your provider or insurer if you have questions about billing or care.
• Schedule an in-person visit if recommended or if symptoms require it.

FAQs

What is a surprise medical bill?

A surprise medical bill happens when you receive care from a provider not covered by your insurance, and you are charged more than expected, often without your knowledge before the visit.

Does the No Surprises Act apply to telemedicine?

Yes, the Act applies to many telemedicine services, but coverage and billing rules can vary. It's important to check with your provider and insurer about costs before your tele-visit.

What should I do if I get a surprise bill?

If you receive a bill that seems unexpected or too high, contact your insurer first to dispute it. You can also seek help from patient advocacy groups or health authorities who handle billing complaints.

Can I choose an out-of-network provider if I want?

You can choose any provider, but if they are out-of-network, you may be responsible for higher costs unless the No Surprises Act protections apply. Always ask about network status and costs before care.

How can I avoid surprise bills?

Check your provider’s network status, understand your insurance coverage, ask for cost estimates before care, and know your rights under the No Surprises Act.

Sources

1. No Surprises Act — U.S. National Library of Medicine.
2. Surprise Medical Bills: What You Need to Know — Centers for Disease Control and Prevention (CDC).
3. Telemedicine and Your Health Coverage — Mayo Clinic.
4. Understanding Your Health Insurance Coverage — Agency for Healthcare Research & Quality (AHRQ).

This guide provides general information about the No Surprises Act and telemedicine billing. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your healthcare provider or insurance representative with any questions about your care or coverage.