If you see a healthcare provider or healthcare facility that isn’t in your health plan’s network of providers and facilities, they might charge you the difference between what your insurance covers and what it does not cover. That amount may be more than you would have been willing to pay for the same service in a facility that your health plan covers.  

When does the No Surprises Act apply?

If you are in a situation where you can’t control who is involved in your care, and you go to a facility outside of your health plan, you might get an unexpected bill with extra charges. A situation outside of your control could be a medical emergency, or a last minute transfer by your usual healthcare facility to an out-of-network provider. These unexpected charges are called “surprise billing.”

Does this apply to Medicare and Medicaid patients?

It is important to note that if you are covered by Medicare or Medicaid, you are already protected from getting “surprise billing.” On the other hand, if you get your health coverage through your employer, a Health Insurance Marketplace, or an individual health insurance plan you purchase directly from an insurance company you are now protected from surprise billing under both federal and state law. 

What does the No Surprises Act cover?

Starting in 2022, under the Federal No Surprises Act, there are a few protections that you should be aware of if you are not covered by Medicare or Medicaid. The federal law:

• Bans surprise bills for most emergency services, even if you get them out-of-network and without approval beforehand.
• Bans out-of-network cost-sharing (like out-of-network coinsurance or copayments) for most emergency and some non-emergency services. You can’t be charged more than in-network cost-sharing for these services.
• Bans out-of-network charges and balance bills for certain additional services (like anesthesiology or radiology) provided by out-of-network providers as part of a patient’s visit to an in-network facility.

Additionally, the federal law requires that health care providers and facilities give you an easy-to-understand notice that explains:

• Your billing protections
• Who to contact if you have concerns that a provider or facility has violated the protections, and 
• That patient consent is required to waive billing protections (i.e., you must receive notice of and consent to being balance billed by an out-of-network provider).

Illinois No Surprises Act

Illinois also has a No Surprises Act. Under Illinois law, you cannot be charged greater out-of-pocket expenses than you would have been for covered, in-network physician or provider services. And, the out-of-network provider should not send you a bill.

What if I am uninsured?

If you are uninsured, in most cases, these new rules make sure you can get a good faith estimate of how much your care will cost before you receive it. Learn more about the federal and state law rules. 

What should I do if to report a No Surprises Act violation?

If you believe you’ve been wrongly billed, you may contact:
Federal No Surprises Helpdesk: 1-800-985-3059
Illinois Department of Insurance Office of Consumer Health Insurance
320 West Washington Street
Springfield, IL 62767
Toll-free: 877-527-9431
TDD: 866-323-5321
Fax: 217-558-2083