The No Surprises Act is the name for a portion of the Consolidated Appropriations Act of 2021. This bill provided consumers legal protections in medical bill situations where the charge for the medical procedure was in excess of a health plan’s allowable charge and the physician billed the unpaid portion to the patient, thus creating a “surprise” for the patient. This situation is particularly common when an out-of-network healthcare provider is used.
The “No Surprises Act” became effective January 1, 2022 and the Centers for Medicare & Medicaid Services (CMS) has clarified that the law generally does not apply to dentists and dental insurance. Exceptions may arise in the context of good faith estimates for dental services given to patients who uninsured or otherwise paid for the dental services without the assistance of dental coverage. Additional exceptions may occur with respect to dental care delivered in hospitals or emergency treatment.
CMS has stated:
“The No Surprises Act protects people covered under group and individual health plans from receiving surprise medical bills when they receive most emergency services, non-emergency services from out-of-network providers at in-network facilities, and services from out-of-network air ambulance service providers. It also establishes an independent dispute resolution process for…uninsured and self-pay individuals when they receive a medical bill that is substantially greater than the good faith estimate they get from the provider.”
Our knowledgeable customer service team will assist you with any questions you may have prior to enrolling in a dental plan. They can guide you through the process of choosing coverage that matches your needs as well as your budget.
