Below is a quick reference of in-network coverage for major hosptial systems.

For emergency care, you pay the same level as In-network. Must be an emergency as defined in your plan, otherwise Not covered. The “No Surprise Act” addresses out of network care and is summarized below.

✓ Indicates in network facilities.

✘ Indicates out of network facilities, emergency use only

Metro Atlanta

Savannah

Bluffton / Hilton Head

No Surprise Act

The “No Surprises Act” is a significant piece of healthcare legislation enacted in the United States to protect consumers from unexpected and often exorbitant medical bills. Officially titled the “No Surprises Act of 2020,” it was included as part of the Consolidated Appropriations Act, 2021, and became effective on January 1, 2022.

This act primarily addresses the issue of surprise medical billing, a situation that arises when patients inadvertently receive care from out-of-network healthcare providers, often during emergencies or at in-network facilities. As a result, patients are unexpectedly billed for the difference between what their insurance covers and the out-of-network provider’s charges, which can lead to significant financial burdens and distress.

Key provisions of the No Surprises Act include:

1. Balance Billing Protection: Under this law, patients are shielded from balance billing. Providers and facilities are required to work directly with insurers to determine appropriate reimbursement for out-of-network care, ensuring that patients are not held responsible for excessive charges beyond what they would pay for in-network care.
2. Emergency Care: The act specifically addresses surprise bills related to emergency services. Patients who receive emergency care will only be responsible for their in-network cost-sharing amounts, regardless of whether the care was provided by an out-of-network provider or facility.
3. Advanced Notice of Network Status: Health insurers must provide clear and upfront information to policyholders about which healthcare providers are in-network and which are out-of-network, making it easier for patients to make informed choices about their healthcare providers.
4. Dispute Resolution: The No Surprises Act establishes an independent dispute resolution (IDR) process to resolve payment disputes between insurers and providers. When they cannot agree on a payment amount, an independent third party steps in to make a final determination.
5. Transparency Requirements: The act includes provisions to enhance transparency in healthcare pricing. Providers are required to make their charges and billing practices more transparent, helping patients understand the potential costs of care.
6. Protection for Non-Emergency Care: While the act’s primary focus is on emergency care, it also provides some protections for non-emergency care situations, such as when patients receive out-of-network services at in-network facilities.

In summary, the No Surprises Act is a crucial piece of legislation aimed at preventing surprise medical bills and protecting consumers from unexpected and unaffordable healthcare costs. It aims to create a fairer and more transparent healthcare system by establishing rules and mechanisms to resolve billing disputes and ensure patients are not financially burdened by out-of-network care.