Surprise billing is a leading cause of medical debt. It is difficult and time consuming to research and resolve. In 2022 consumers got additional protections and access to assistance under the No Surprises Act.

It arises from the complexity of our medical delivery and payment systems. The ACA and employer’s many different plans are privately insured by a variety of companies. Their costs and billing differ by plan type (HMO, PPO, HSA, Fee for Service, POS). All of this is on top of highly specialized procedures that usually require a team of doctors and nurses for different disciplines and often different companies. When there is an emergency, this complexity makes good communication problematic. CMS provides ground rules that prohibit the most frequent causes including:

1. Out-of-network providers at in-network facilities and air ambulances from out-of- network providers

2. Good faith estimates of costs for self-pay patients

3. Independent dispute resolution and appeals processes

4. Requirements for more information on drug and health care costs