No Surprises Act

Under the law, health care providers need to give patients who don’t have certain types of health care coverage or who are not using certain types of health care coverage an estimate of their bill for health care items and services before those items or services are provided.

• You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

• If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling. You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask.

• If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill. Connecticut passed its own law in 2015 to address balance billing. The law applies to health plans regulated by Connecticut’s Department of Insurance and has similar protections to those provided under the federal No Surprises Act. For more information, see Conn. Gen. Stat. §§ 38a-477aa and 20-7f or the Connecticut Department of Insurance website.

• New York passed its own law in 2014 to address surprise bills. The law applies to health plans regulated by New York’s Department of Financial Services and has similar protections to those provided under the federal No Surprises Act. For more information see the New York Department of Financial Services website.
  
  

Make sure to save a copy or picture of your Good Faith Estimate and the bill.

For questions or more information about your right to a Good Faith Estimate, visit cms.gov/nosurprises/consumers, email FederalPPDRQuestions@cms.hhs.gov, or call (800)-985-3059.