The No Surprises Act took effect Jan. 1, protecting consumers from unexpected charges for medical care from out-of-network providers or facilities. This includes insurance through your employer, the federal Marketplace or an individual plan you purchased.
If you’re uninsured or you decide not to use your health insurance for a service, with the new policy, you can often get a good faith estimate for the charges beforehand.
For services received in 2022, you can file a dispute if you receive a medical bill $400 or more above the estimate you were given. Most insurance cards show a member services phone number and/or website for your questions.
If you plan to have a procedure done, contact your insurance company to get pre-authorization. At that time, you’ll be told whether the provider and facility you’ve chosen are in your network.
All health insurance is required to help pay for 10 Essential Health Benefits. The essential benefits are:
1. Outpatient (clinic) care
2. Lab tests
3. Prescription medications
4. Preventive, wellness and chronic disease management
5. Emergency situations
6. Hospitalization
7. Pre-natal and infant delivery
8. Behavioral health, including substance use
9. Services and devices needed after an injury
10. Dental and vision for children
For more information, visit the federal Substance Abuse and Mental Health Services Administration website.
Ann Cochran is the health navigation coordinator in the Dallas County Public Health Department.
