It’s been a year since Nebraska’s LB997 (Out-of-Network Emergency Medical Care Act) has blocked health care providers in Nebraska from balance billing consumers for medical care received from out-of-network providers or facilities in emergency situations. The protections under that state mandate were expanded when the federal No Surprises Act came into effect on Jan. 1, 2022.
The No Surprises Act protects consumers from excessive out-of-pocket health care costs and surprise medical bills. The law requires health insurers and health care providers to work together to make sure consumers are informed and protected.
What is a surprise medical bill?
An unexpected, or surprise, medical bill happens when you cannot control who’s involved in your care, such as when you receive care during a medical emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.
What is balance billing?
Balance billing happens when an out-of-network provider bills you for the difference between what the insurer pays and what the provider charges.
What does the No Surprises Act do?
- The No Surprises Act protects consumers from being balance billed in these situations:
- Emergency services
- Out-of-network providers and facilities cannot balance bill you for covered services you receive resulting from a medical emergency, including air ambulance services. The most they can charge you is your in-network cost share. This includes covered services you receive once you’re in stable condition, unless you give written consent to remove these protections.
- Certain services at an in-network hospital or ambulatory surgical center
- Out-of-network providers who work at in-network hospitals or ambulatory surgical centers cannot balance bill you for covered services. The most they can charge you is your in-network cost share unless you give written consent to remove these protections.
- Emergency services
- Additionally, these providers cannot ask you to give up your protections through written consent:
- Emergency medicine
- Assistant surgeon
- Hospitalist or intensivist services
How does the act protect consumers from receiving a surprise bill?
- With the protections of the No Surprises Act, you only have to pay your applicable in-network cost share, such as your copay, coinsurance and/or deductible.
- Insurance carriers will pay out-of-network providers and facilities directly and provide you with an Explanation of Benefits (EOB) that clearly outlines your financial responsibility.
- Insurance carriers will cover emergency services without requiring you or your provider to get prior approval.
- Insurance carriers will also count any amount you pay for No Surprises Act-protected claims toward your in-network deductible and out-of-pocket maximum (the most you will pay for covered services during the year).
Does the law apply to everyone, no matter what type of health plan?
The No Surprises Act applies to those with individual* or group health insurance, self-funded plans, church plans, grandfathered plans, grandmothered plans and federal employee plans.
The law does not apply to Medicare, Medicaid and other public programs as they already generally prohibit balance billing.
*The law does not apply to short-term limited duration plans, such as Blue Cross and Blue Shield of Nebraska’s (BCBSNE) Armor Health individual and family plans.
What should you do if you think you have received a surprise medical bill?
BCBSNE believes no one should receive a surprise medical bill, especially when you’ve done all you can to get care in-network. BCBSNE will work with providers to ensure members do not receive a surprise medical bill or a balance bill. If you are a BCBSNE member and think you have been wrongly billed, contact the Member Services department at the number on the back of your BCBSNE member ID card.
Where can you learn more?
Remember, you are never required to give up your protections from balance billing.
Note that your costs of care will always be lowest when you get services from in-network providers and facilities. To find in-network providers, log into your myNebraskaBlue.com account or visit NebraskaBlue.com/Find-A-Doctor.
Learn more about your rights and protections against surprise medical bills.
For more information about the No Surprises Act, including additional information regarding consumer protections, please visit CMS.gov/NoSurprises.