The No Surprises Act and Your Right to a Good Faith Estimate

The No Surprises Act is a federal law that went into effect on January 1, 2022, to provide protections against certain unexpected medical bills for most emergency, and some non-emergency, services. Many states, including the state of Virginia, have also enacted laws protecting consumers against surprise medical bills. 

Under the No Surprises Act you have the right to receive a “Good Faith Estimate” explaining how much your scheduled health care service will cost. 

Under the law, health care providers need to give patients who don’t have certain types of health care coverage or who are not using certain types of health care coverage an estimate of their bill for health care items and services before those items or services are provided. 

• You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees. 

• If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling. You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask. 

• If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill. 

If you want to learn more about the No Surprises Act, please visit the Center for Medicare & Medicaid Services at cms.gov/nosurprises/consumers, email [email protected], or call 1- 800-985-3059. 

You may also visit the Commonwealth of Virginia State Corporation Commission at scc.virginia.gov/pages/Balance-Billing-Protection for more information about your billing protections under Virginia law. 

For specific consumer billing protections regarding other states with current laws in place, you may visit the Commonwealth Fund’s map of states with billing protections at www.commonwealthfund.org.