Your Rights and Protections Against Surprise Medical Bills

The “No Surprises Act” (NSA) is a federal law designed to protect you from unexpected medical bills. You are protected from “surprise billing” (also called “balance billing”) when you receive certain services from an out-of-network provider or facility.

What is a Surprise Bill?

A surprise bill is an unexpected bill from a healthcare provider or facility that is not in your health plan’s network. This can happen when you receive care from an out-of-network provider at an in-network facility, or during an emergency. “Balance billing” is when an out-of-network provider bills you for the difference between what they charge and what your insurance plan pays.

When You Are Protected from Balance Billing

• Emergency Services: If you receive emergency services from an out-of-network provider or facility, the most they can bill you is your plan’s in-network cost-sharing amount.
• Non-Emergency Services at an In-Network Facility: When you receive services at an in-network hospital or ambulatory surgical center, certain out-of-network providers (e.g., anesthesiologists, radiologists) cannot balance bill you.

You Have the Right to a “Good Faith Estimate”

If you are an uninsured or self-pay patient, you have the right to receive a “Good Faith Estimate” of the total expected cost of any non-emergency items or services. This estimate includes related costs like medical tests, prescription drugs, and other fees.

• Your healthcare provider must give you a Good Faith Estimate in writing at least one business day before your medical service is scheduled if the appointment is booked at least three business days in advance.
• You can also ask for a Good Faith Estimate before you schedule a service.
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. You must initiate the dispute within 120 days of the bill.

Consent to Waive Your Protections

For certain non-emergency services, an out-of-network provider may ask you to sign a notice and consent form to waive your protections against surprise billing. You are never required to sign this form or give up your protections. By not signing, you may choose to get care from a provider in your plan’s network.

Georgia State Protections

Georgia’s Surprise Billing Consumer Protection Act also provides protections for patients. This state law, which applies to fully insured health plans and certain government plans, prohibits balance billing for covered emergency and non-emergency services from out-of-network providers.

What to Do if You Receive a Surprise Bill

If you believe you have received a bill that does not comply with these protections, you can take the following steps:

1. Contact Acworth Outpatient Treatment and your health plan to try and resolve the issue.
2. If your concerns are not resolved, you can contact the Centers for Medicare & Medicaid Services (CMS) or the Georgia Office of the Commissioner of Insurance and Safety Fire.

Contact Information for Assistance:

• Acworth Outpatient Treatment:
  • Address: 6060 Lake Acworth Drive Suite G, Acworth, GA 30101
• CMS No Surprises Help Desk: 1-800-985-3059 or visit www.cms.gov/nosurprises
• Georgia Office of the Commissioner of Insurance and Safety Fire: (404) 656-2070 or visit oci.georgia.gov