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We don’t sell insurance, and we don’t profit financially from our research, education, or free assistance services. As a Maine public charity, we are dedicated to helping all Maine people obtain quality, affordable health care.
We are the experts.
For over 30 years we have been a single issue organization. 100% of our time is devoted to analyzing, reporting on, and assisting people with health coverage issues – and that makes us unique! All of our research and analysis is focused on how health policy impacts health care consumers. We represent consumer interests by providing input in the rulemaking process, participating in work groups and committees, and by taking legal action when necessary. We also help keep the public and policy leaders informed through our reports, fact sheets, newsletters and other publications.
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No Surprises Act:
On January 1, 2022 the federal No Surprises Act (NSA) went into effect, the result of a bipartisan effort to limit consumer liability for unexpected out-of-network charges for medical care. Surprise bills often occur when consumers receive emergency care, but also arise in cases where multiple providers furnish treatment. According to Kaiser Family Foundation (KFF), two out of three Americans are worried about unexpected medical bills. And in a Petersen-KFF study, one in five emergency claims and one in six in-network hospitalizations include at least one out-of-network bill.
KFF has produced a short video explaining NSA. Basically, the law requires health insurance companies to cover certain out-of-network services as though they are in-network and apply in-network cost sharing. NSA applies to both employer-based plans and private insurance. The law protects consumers in most emergency situations in hospitals, free-standing emergency centers, and urgent care centers. It also applies to air ambulance services (but not ground ambulance). Consumers will also be protected by NSA in post-emergency “stabilization” situations and some non-emergency services provided at in-network facilities.
NSA also prohibits balance billing, i.e., when providers hold consumers liable for the difference between what they charge and the amount the insurance company “allows.” There is an exception in non-emergency situations, however, when the provider furnishes the consumer with written notice at least 72 hours in advance and obtains the consumer’s written consent.
Maine law already protects consumers from surprise medical bills. It requires insurers to hold enrollees harmless for amounts beyond in-network level of cost sharing. Maine law also prohibits out-of-network providers from billing enrollees for any amount beyond in-network level of cost sharing.