No Surprises Act
Starting January 1, 2022, the No Surprises Act steps in to protect you from unexpected medical bills. Passed by Congress as part of the Consolidated Appropriations Act of 2021, this law ensures that if you receive emergency care at an out-of-network facility—or see an out-of-network provider at an in-network hospital—you’ll only be responsible for your usual in-network costs. No more surprise charges popping up when you least expect them.
And if you don’t have insurance, the Act has your back too. It requires providers to give you a good faith estimate of what your care will cost upfront, so you can plan without any unwelcome surprises.
Balance Billing
When you visit a doctor or any health care provider, you might have to cover some out-of-pocket costs—things like copayments, coinsurance, or deductibles. But here’s the catch: if you see a provider or go to a facility that isn’t part of your health plan’s network, you might end up paying more, or even the full bill.
“Out-of-network” means the provider or facility hasn’t signed a contract with your health plan. These out-of-network providers can sometimes send you a bill for the difference between what your plan pays and what they charge—this is called “balance billing.” And heads up, that extra amount usually costs more than what you’d pay for the same service in-network, and it might not count toward your yearly out-of-pocket max.
“Surprise billing” is when you get hit with a balance bill unexpectedly—like during an emergency or if you go to an in-network hospital but are treated by an out-of-network provider without your knowledge.
Here’s the good news: you don’t have to give up your protections against balance billing. And you’re never required to get care out-of-network—you always have the choice to stick with providers and facilities in your plan’s network.
On top of that, Georgia law makes sure you’re only responsible for your in-network cost-sharing amount. These protections apply if you have coverage through a state healthcare plan, a managed care plan, or a third party that opts into the balance billing ban.
Good Faith Estimate
You have the right to know upfront how much your medical care will cost—that’s where the “Good Faith Estimate” comes in.
By law, if you don’t have insurance or aren’t using it, healthcare providers have to give you an estimate of what your bill will be for medical services and items.
This estimate covers the total expected cost for any non-emergency care, including things like tests, prescription medications, equipment, and hospital fees.
Be sure to get your Good Faith Estimate in writing at least one business day before your appointment or procedure. And don’t hesitate to ask your provider—or any other provider you’re considering—for this estimate before you schedule anything.
If you ever get a bill that’s $400 or more above your Good Faith Estimate, you have the right to dispute it.
Keep a copy or take a photo of your Good Faith Estimate—it’s your best friend if questions come up later.
