July 3rd, 2024 – While most people enjoy a good surprise, getting a surprise bill is never a good thing. The federal No Surprises Act gives employees and individuals with health insurance in Colorado a number of protections against surprise medical bills.

Surprise medical bills sometimes come about when a person received out of network care due to an emergency or an accident, but it can also result from a balance billing when an in-network provider charges more than the agreed upon rate between the provider and the contracted health insurer.

The No Surprises Act helps protect insured individuals when they have an emergency or accident and didn’t have an opportunity to pick their provider. It can also protect people in non-emergency situations from balance billing when they go to an in-network facility and receive care from an out of network provider. The balance billing protection applies when the facility is a hospital, ER or ambulatory surgical center.

The No Surprises Act can also protect people from emergency air ambulance transport, which was a big issue for people having medical emergencies in Colorado’s rural areas and ski hills being air evacced to metro-Denver.

If you receive an bill or Explanation of Benefits that you think is covered by the No Surprises Act you can reference that in an appeal with the carrier or subsequent complaint filed with with the Colorado Division of Insurance in the event of an unsuccessful appeal or you can call the No Surprises Help Desk at 800-985-3059.