No Surprise Billing and Idaho Patient Care Act

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No Surprises Act & Good Faith Estimates

Under the law, health care providers need to give patients who do not have insurance or who are not using insurance an estimate of the bill for medical items and services. 

No Surprises Act & Good Faith Estimates

Your Rights and Protections Against Surprise Medical Bills

When you get emergency care or get treated by an out-of-network provider or at an ambulatory surgical center, you are protected from surprise billing or balance billing.

Under Section 112 of the No Surprises Act, beginning January 1, 2022, individual healthcare providers and facilities must provide a “good faith estimate” of the total expected charges to the patient’s plan or insurer (if the patient is insured and using his or her coverage) or directly to the uninsured or self-pay patient upon request or scheduling of a service.

What is “balance billing” (sometimes called “surprise billing”)?

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a healthcare facility that isn’t in your health plan’s network. “Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.