The No Surprises Act prohibits out-of-network providers from pursuing members directly for medical balance bills in situations where the patient has little or no control over who provides their care. This includes all emergency services (except ground ambulances), or when an out-of-network provider is involved in their care while they are at an in-network facility. As a result, patients will be protected from balance bills in most situations where they have little or no control over who provides their care.
However, the No Surprises Act does not apply if the member chooses to receive items and services from an out-of-network provider. The law also does not apply for ground ambulance services, or when the law’s notice and consent requirements are met for certain non-ancillary services provided at in-network facilities.
The No Surprises Act also establishes an Independent Dispute Resolution (IDR) process, also referred to as arbitration, to resolve disputes between OON providers and insurers/health plans.