Effective January 1, 2023: Protections against unexpected medical bills

At NJ Vein Specialists, we are committed to transparent billing practices and upholding your rights under The No Surprises Act. This Act provides crucial protections to patients, ensuring you are not faced with unexpected or “surprise” medical bills, especially when receiving emergency care or services from out-of-network providers at in-network facilities.

What is balance billing or surprise billing?

Balance billing occurs when you are charged the difference between what your insurance plan covers and the total fee for services, typically by an out-of-network provider. Surprise billing is a form of balance billing that happens unexpectedly, such as during an emergency or when an out-of-network provider treats you at an in-network facility.

How does this Act protect you?

You are safeguarded from balance billing in the following scenarios:

  • Emergency services: If you receive emergency care from an out-of-network provider or facility, they can only bill you for the in-network cost-sharing amount, including what is due in copayments, coinsurance, and deductibles. Post-stabilization services are also covered unless you explicitly consent to waive these protections in writing.
  • Certain In-network facility services: At an in-network hospital or ambulatory surgical center, if out-of-network providers (such as anesthesiologists or radiologists) treat you, they can only bill you the in-network cost-sharing amount. These providers cannot balance bill you unless you provide written consent to receive out-of-network care.

Additional state protections in New Jersey

In New Jersey, these protections extend to inadvertent out-of-network services and emergency or urgent care services provided out-of-network at an in-network facility.

You're protected against billing if: 

You participate in a self-funded insurance plan or decline to be treated at an out-of-network facility. 

When is balance building not permitted?

You are only responsible for your share of the cost (copayments, coinsurance, deductible).

  • Your health plan is required to cover emergency services without the need to get prior authorization.
  • Services by out-of-network providers must be covered.
  • Your cost-sharing amount must be based on in-network rates.
  • Any amount you pay must count towards your in-network deductible and out-of-pocket limits.

NJ Vein Specialists’ commitment to patient care and transparency

Our team at NJ Vein Specialists is dedicated to providing you with the highest quality of vein care without the worry of unexpected financial burdens. We work with a wide range of insurance providers, and our knowledgeable staff is here to help you navigate your coverage and assist you with financing options.

Contact us for any billing questions.

If you have concerns about insurance coverage or the cost of treatment, we encourage you to contact NJ Vein Specialists. Our goal is to ensure that you receive the care you need with the financial peace of mind you deserve. Schedule a consultation with us today to discuss your treatment options and insurance coverage under The No Surprises Act.

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