No Surprises Act

Balance billing occurs when you receive care from an out-of-network provider or facility and are billed for the difference between what your health plan pays and what the provider charges. This often happens without your knowledge—hence the term “surprise billing.”

When you get care at an in-network facility but are treated by an out-of-network provider, you might be unexpectedly charged more than expected. The No Surprises Act protects you from these surprise bills in specific situations.

1. Emergency Services

You cannot be balance billed for:

• Emergency care from an out-of-network provider or facility.
   
• Post-stabilization care (after you’re stable), unless you give written consent and knowingly waive your protections.
   

If you're at an in-network hospital, ambulatory surgical center, or similar facility:

• Certain providers (e.g., radiologists, anesthesiologists, pathologists) cannot balance bill you.
   
• You are only responsible for your usual in-network cost-sharing (copays, coinsurance, or deductible).
   
• You do not have to waive your rights—this is optional and should never be pressured.
   

When balance billing is not allowed:

• You are only responsible for in-network rates.
   
• Your insurance must cover emergency care without prior authorization.
   
• Any amounts you pay for emergency or protected out-of-network services count toward your in-network deductible and out-of-pocket max.
   
• The provider/facility will bill your insurance directly.
   

If you are insured under a plan regulated by the state of Nevada, you may also be protected under Nevada’s Balance Billing Laws.
Learn more: https://doi.nv.gov

If you’re uninsured or not using insurance, you are entitled to a Good Faith Estimate of your expected medical costs.

Key GFE Protections:

• You must receive a written estimate at least 1 business day before non-emergency services.
   
• The estimate must include all related costs: labs, medications, imaging, etc.
   
• If your bill is $400 or more than your GFE, you can initiate a dispute.
   

Learn more or file a dispute: www.cms.gov/nosurprises or call 1-800-985-3059.

If you believe you’ve been wrongly billed or have questions:
Med-Care Providers

Phone: 702.723.0303
Email: info@med-careproviders.com