No Surprise Act & Good Faith Estimate
No Surprises Act
Your Rights and Protections Against Surprise Medical Bills
When you receive emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing, also known as "surprise billing." In these situations, you should not be charged more than your health plan's in-network copayment, coinsurance, or deductible.
What Is Balance Billing?
When you receive care from a provider or facility that is not part of your health plan's network, you may be billed for the difference between what your insurance pays and the provider's full charge. This practice is known as balance billing.
A surprise medical bill can occur when you are unable to choose the provider involved in your care, such as during an emergency or when receiving services at an in-network facility from an out-of-network provider.
Protections for Emergency Services
If you have an emergency medical condition and receive emergency services from an out-of-network provider or hospital, you cannot be balance billed for those services. Your responsibility is limited to your plan's in-network cost-sharing amount, including copayments, coinsurance, and deductibles.
Protections at In-Network Facilities
When you receive care at an in-network hospital or ambulatory surgical center, certain providers involved in your care may be out-of-network. Federal and New York State laws protect you from balance billing for services including:
- Emergency medicine
- Anesthesia
- Pathology
- Radiology
- Laboratory services
- Neonatology
- Assistant surgeon services
- Hospitalist services
- Intensivist services
Additional Patient Protections
When balance billing is not allowed:
- You are responsible only for your in-network cost-sharing amounts.
- Your health plan must pay any additional covered costs directly to the provider.
- Emergency services must be covered without prior authorization.
- Amounts you pay for protected services count toward your deductible and out-of-pocket maximum.
Questions or Concerns?
If you believe you have been incorrectly billed and your coverage is subject to New York State law, contact:
New York State Department of Financial Services
Phone: (800) 342-3736
Email:
surprisemedicalbills@dfs.ny.gov
For coverage governed by federal law, contact:
Centers for Medicare & Medicaid Services (CMS)
Phone: 1-800-985-3059
Good Faith Estimate for Uninsured or Self-Pay Patients
Know Your Expected Costs Before Receiving Care
Under federal law, patients who do not have health insurance or who choose not to use their insurance have the right to receive a Good Faith Estimate of the expected charges for medical services.
A Good Faith Estimate helps you understand the anticipated cost of your care before you receive treatment.
What Is Included?
A Good Faith Estimate may include expected charges for:
- Medical services
- Hospital fees
- Diagnostic testing
- Prescription medications
- Medical equipment
- Other related healthcare costs
Your Rights
- You have the right to receive a written Good Faith Estimate for non-emergency medical services.
- You may request a Good Faith Estimate before scheduling a service.
- Providers are generally required to provide the estimate at least one business day before your scheduled service.
- If your final bill is $400 or more above your Good Faith Estimate, you may have the right to dispute the charges.
Questions?
For more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.
You may also contact:
Niagara Falls Memorial Medical Center Financial Counseling
Phone: (716) 278-4112
