No Surprises Act FAQ

Out of Network Billing Restrictions

Why are you giving me this notice?

The No Surprises Act – a new federal law – requires that we give a copy of this notice to all insured patients.  The information is also available on our website.

Does this apply to my insurance?

The No Surprises Act applies to most commercial insurance plans, regardless of whether you have coverage through your employer or the individual market.  However, the law does not apply to coverage that you may have through Medicare, Medicaid, Champus, or Tricare as those programs already have balance billing protections in place.

What services does this apply to?

The No Surprises Act applies to emergency medical services or post-stabilization services where Boone Health or a provider involved in your care at Boone Health are out of network with your insurance.  It also applies to services you receive from an out-of-network provider at Boone Health when Boone Health is in-network with your insurance.

What does the No Surprises Act do for me?

When you receive services that are covered by the No Surprises Act, the Act 1) requires the out-of-network healthcare provider to submit claims to your insurance; 2) requires your insurance process the claim at in-network co-payment amounts; 3) prohibits the out-of-network provider from balance billing you for more than the in-network co-payment amount; and 4) requires the out-of-network provider and insurance company to resolve any disagreements regarding the payment amount through a dispute resolution process.

How can I find out if a provider is in-network?

For information regarding the networks with which Boone Health participates, go to https://boone.health/patients-visitors/before-after-your-stay/accepted-insurance/.  For information regarding providers that are in-network with your insurance, go to the website on your insurance card.

I’m receiving services in the emergency department.  Will this apply to me?

Yes.  The No Surprises Act applies to all out-of-network providers who may be involved in your emergency medical care.

I need to be hospitalized from the emergency department.  Will this apply to me?  Yes.  The No Surprises Act applies to all out-of-network providers who may be involved in the stabilization hospital care you receive following an emergency room visit at Boone Health.

I’m scheduling services at the hospital and Boone Health is in-network with my insurance.  Will this apply to me?  Yes.  The No Surprises Act will apply to any out-of-network providers who are involved in your care at Boone Health.  In some situations, these out-of-network providers may notify you of their out-of-network status and request you consent to their involvement in your care as out-of-network providers.  If you sign a consent with an out-of-network provider, the No Surprises Act billing restrictions will no longer apply and the out-of-network provider will be permitted to bill you for any costs not covered by your insurance.

I’m scheduling services at the hospital and Boone Health is out-of-network with my insurance.  Will this apply to me?

No.  When the services are not emergency services, the No Surprises Act only applies if Boone Health is in-network.  When you choose to receive non-emergency services from Boone Health when Boone Health is out-of-network with your insurance, the services of Boone Health and any other providers who are out-of-network will be processed by your insurance under your out-of-network coverage, if any.

I’m scheduling services in the office.  Will this apply to me?

No.  The No Surprises Act out-of-network billing restrictions only apply to services provided at a hospital or ambulatory surgery center. 

Who can I call if I have questions?

If you have questions, please contact Boone Health at 1-888-538-1535. 

Good Faith Estimate for Self Pay Patients

Who is considered Self Pay?

For purposes of the Good Faith Estimate, a patient is considered Self Pay if they do not have insurance or if they will not be using insurance for a particular service.

My insurance is out-of-network, will I be treated as Self Pay?

No.  If a claim is being submitted to your insurance, regardless of in-network or out-of-network status, you are not considered Self Pay for purposes of the Good Faith Estimate.

When will I receive my estimate?

If you are making an appointment at least ten business days in advance of the service, your Good Faith Estimate will be provided within three business days.  If you are making an appointment three to ten business days in advance of the service, your Good Faith Estimate will be provided within one business day.  If you request a Good Faith Estimate for a service, it will be provided within three business days.

I’m scheduling a same-day service.  Will I receive an estimate?

Not unless you request the Good Faith Estimate, in which case it will be provided within three business days.

What will my estimate include?

Your estimate will include a description of anticipated services and the related cost.  Please note that the final services actually provided to you may vary from the estimate based on the recommendations of your physician or health care provider. 

What if other providers are involved in my service?

Beginning December 31, 2022, your Good Faith Estimate will include estimates from all providers who are expected to be involved in your service.  Until that time, some co-providers may not be included.  If a co-provider is not included in your Good Faith Estimate, you may request a Good Faith Estimate directly from that provider.

How do I find out if I qualify for financial assistance?

To determine whether you qualify for financial assistance, please contact 1-888-538-1535.

What if my bill is more than my estimate?

If your bill is more than $400 higher than your estimate, you may be able to initiate a dispute process.  For more information regarding the dispute process, go to https://www.cms.gov/nosurprises/consumers/medical-bill-disagreements-if-you-are-uninsured.

Who can I call if I have questions?

If you have questions, please contact Boone Health at 1-888-538-1535.