As of January 1, 2022, new federal rules under the No Surprises Act offer important protections for consumers receiving emergency care, non-emergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers.

These rules help restrict excessive out-of-pocket costs and ensure emergency services are covered without prior authorization, regardless of whether the provider or facility is in-network.

What Does This Mean for You?

Before these protections, even if you had health insurance, getting care from an out-of-network provider often meant higher costs. This was especially common in emergencies when you couldn’t choose your provider. Even at an in-network hospital, some providers might be out-of-network and could bill you separately.

This practice is called balance billing—where the provider bills you the difference between what your insurance pays and what they charge. When unexpected, these bills are called surprise bills.

Federal Legislation Protecting You

The Consolidated Appropriations Act of 2021, enacted December 27, 2020, includes:

• The No Surprises Act (Title I), protecting consumers from surprise medical bills
• Provisions on transparency (Title II) to help you understand costs upfront

Learn more about your rights, how to understand your medical costs in advance, and what to do if payment disagreements happen after care.

Resources to Learn More:

• No Surprises Act Overview at CMS.gov
• Consumer Protections and Billing Transparency

At Positive Reset Mental Health Clinic, New Jersey, we support your mental health journey with clear communication and billing transparency every step of the way.