These regulations intend to protect members from certain unexpected bills, or “balance bills,” for out-of-network emergency services, care by out-of-network providers at an in-network facility, and out-of-network air ambulance service. A “balance bill” is the difference between what your health plan agreed to pay for a service and the full amount charged for a service.
Prior to the No Surprises Act, if you received services from an out-of-network provider, the provider was usually permitted to bill you this additional amount. Most likely, the additional amount did not count toward your annual out-of-pocket maximum. The No Surprises Act protects members from having to make certain additional payments by prohibiting balance billing for out-of-network emergency services, care by out-of-network providers at an in-network facility and out-of-network air ambulance services.
