What is the No Surprises Act?

Under the No Surprises Act (H.R. 133 - effective January 1, 2022), health care providers need to give clients
or patients who do not have insurance or who are not using insurance an estimate of the bill for medical items and services.

This Good Faith Estimate shows the costs of items and services that are reasonably expected for your health
care needs for an item or service. The estimate is based on information known at the time the estimate was
created.

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a
co-payment, co-insurance, 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.

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You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.

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You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items
or services. This includes (under the law/when applicable) related costs like medical tests, prescription drugs,
equipment, and hospital fees. The Good Faith Estimate does not include any unknown or unexpected costs
that may arise during treatment. You could be charged more if complications or special circumstances occur.
If this happens, federal law allows you to dispute (appeal) the bill.

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If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. You
may contact the health care provider or facility listed to let them know the billed charges are higher than the
Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate
the bill, or ask if there is financial assistance available.

You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill.

There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will
have to pay the price on this Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.

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MAKE SURE YOUR HEALTH CARE PROVIDER GIVES YOU A GOOD FAITH ESTIMATE WITHIN THE FOLLOWING TIMEFRAMES:

• If the service is scheduled at least three business days before the appointment date, no later than one business day after the date of scheduling;

• If the service is scheduled at least 10 business days before the appointment date, no later than three business days after the date of scheduling; or

• If the uninsured or self-pay patient requests a good faith estimate (without scheduling the service), no later than three business days after the date of the request. A new good faith estimate must be provided, within the specified timeframes if the patient reschedules the requested item or service.

The No Surprises Act has a universal waiver form required as well as a public disclosure of the “Good Faith
Estimate.”

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Note: A Good Faith Estimate is for your awareness only. It does NOT involve you needing to make any type of commitment.

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To learn more and get a form to start the process, go to www.cms.gov/nosurprises or call (800) 985-3059. For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call (800) 985-3059. If you have questions or concerns, please reach out.

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Click here for more information about your rights under Federal law.

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Click here for more information about your rights under New Jersey state law.

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