Surprise Medical Bills

"Surprise medical bills" are when you get an unexpected bill from an out-of-network provider for an amount that exceeds the patient's cost-sharing obligation that would have applied had the services been provided by an in-network provider. The Surprise Billing Act protects patients from unexpected billing costs. This means that you may receive separate bills for your out-of-network provider. 

When patients receive emergency care or are treated by an out-of-network provider at an in-network hospital, they are protected from surprise billing. Patients shouldn’t be charged more than the insurance plan’s in-network copayments, coinsurance and/or deductible.

What are surprise medical bills?

A surprise medical bill is when an out-of-network provider bills a patient for the difference between the charges the provider billed, and the amount paid by the consumer’s health plan. This is known as balance billing. When a patient receives a bill for the difference, it is an unexpected balance bill or a surprise bill. If a patient knowingly chooses to receive services from a nonparticipating provider, balance billing is allowed for non-emergency care.

The 2022 No Surprises Act

The No Surprises Act, protects patients insured under group and individual health plans from receiving surprise medical bills for most services. These include emergency and non-emergency services from out-of-network providers working at in-network facilities.

The No Surprises Act also provides a dispute resolution process for payment disputes between plans and providers and allows an opportunity for uninsured and self-pay individuals to dispute bills that are greater than the Good Faith Estimate they get from the provider.

What is a Good Faith Estimate?

Health care providers are required to give scheduled uninsured or self-pay patients an estimate of the bill for medical items or services.

Prior to a scheduled service, patients have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency services. This also includes costs such as medical tests, prescription drugs, equipment and hospital fees. Patients should request a Good Faith Estimate in writing at least 1 business day before the medical service or while scheduling.

If a patient receives a bill that is $400 or more than the Good Faith Estimate, the bill can be disputed.

What is protected from Surprise Billing?

If you receive emergency care out-of-network, you may only be responsible for paying what you would owe in-network, such as co-payments or deductibles. Your care can continue until you have been stabilized. Providers cannot bill your services until you have been stabilized.

Other services?

UNM Health Can Help

If a patient believes they have been wrongly billed, they may contact a UNM Health Patient Financial Services Specialist at the following locations.