Helping you understand your new rights under the “No Surprises Act”

What is the “No Surprises Act?”

The 2020 “No Surprises Act” helps alleviate the problem of patients receiving an unexpected bill in an emergency situation or when they are out-of-network. On January 1, 2022, new provisions of the Act went into effect.

Details of the Act may be downloaded in English or Spanish down below.

What is “surprise billing?”

When a person with a group health plan or health insurance coverage gets care from an out-of-network provider, their health plan or issuer typically does not cover the entire out-of-network cost, leaving eh person with higher costs than if they had been seen by an in-network provider. In many cases, the out-of-network provider can bill the person for the difference between the billed charge and the amount paid by their plan or insurance, unless prohibited by state law. This is known as “balance billing.” An unexpected balance bill is called a surprise bill.

How does that impact me?

The new provisions of the No Surprises Act forbid balance billing in certain situations involving out-of-network care or emergency care. The Act requires that self-pay patients receive an estimate for certain scheduled services at or near the time of scheduling.

How will Morton County Health System handle out-of-network situations?

To help ensure that our patients are seen in-network, Morton County Health System will proactively help direct patients to an in-network provider or facility whenever possible. Please confirm that your insurance plan is in-network for Morton County Health System. You’ll find a customer service number on your insurance documentation.

Why did I get an estimate for future services?

The Act requires that self-pay patients (patients without insurance, patients with medical sharing ministry plans, or patients not planning on filing their charges to their insurance company) be sent an estimate within 1-3 days of scheduling their appointment.

What if I don’t plan on having my charges filed to my insurance company for my upcoming visit?

If you don’t plan on having your charges filed to your insurance carrier at your visit, please indicate that at scheduling.

What happens if I am a self-pay patient and no estimate was sent to me?

The Act requires that we generate an estimate for you. If no estimate is sent, we are required to reschedule your visit. Our staff attempts to make sure that any self-pay patient is sent an estimate once their appointment is scheduled. However, if a patient’s insurance status changes between the time of scheduling and the visit itself, we may be unaware of the change in your insurance status. If your insurance status has recently changed to self-pay, please contact our billing department at (620) 697-2141 to make sure we send an estimate to you prior to your visit.

I’d like to know in advance what my visit will cost. Can I get an estimate?

Our billing department will be happy to help you with an estimate at (620) 697-2141. Click here to learn more about MCHS price transparency and estimates.

What if my final billed charges are more than my estimate?

The estimate we provide takes into consideration insurance coverage, co-payments, deductibles, coinsurance, and other factors that may affect your out-of-pocket costs based on information provided by you and your insurer(s). Expected charges are estimates. Final billed charges on the bill may vary from the estimate because of the patient’s medical conditions, circumstances or complications, final diagnoses, or treatments ordered by a patient’s attending physicians that may need to be scheduled separately. Your estimate does not include professional service fees charged outside of Morton County Health System, such as those provided by a radiologist, pathologist, anesthesiologist, or other independent providers.

Estimates for patients with insurance coverage can change frequently as the remaining deductible and co-insurance change over their plan year. For that reason, for non-self-pay patients, an estimate is only valid for 30 days from the date shown on the estimate. Any time you have questions regarding your estimate or billing statement, please contact the Morton County Health System billing department.