Unveiling Wisconsin’s Protection Against Unexpected Medical Bills
TL/DR –
The No Surprises Act (NSA), active since 2022, protects American consumers from surprise bills for covered emergency out-of-network services, such as air ambulance services, and non-emergency services at an in-network facility. The Wisconsin Office of the Commissioner of Insurance is the primary enforcer of the NSA in Wisconsin and investigates any complaints. However, ground ambulances, unlike air ambulances, are exemptions to the federal protections provided by the NSA.
American Consumers’ Emergency Care Billing Protections Since 2022
The No Surprises Act (NSA) has been providing billing protections to American consumers during emergency care since 2022. It safeguards you against surprise bills for covered emergency out-of-network services, including air ambulance services, and unexpected bills for covered non-emergency services at an in-network facility, as stated by the Wisconsin Office of the Commissioner of Insurance online.
Wisconsin Office as Primary Enforcer of NSA
The office also serves as the primary enforcer of the NSA in Wisconsin, investigating any complaints reported by customers.
Insights on Ground Ambulances’ Coverage
Ground ambulances, in contrast to air ambulances, are not covered by federal protections under the No Surprises Act. The office has seen various approaches by insurance providers towards these exceptions, according to Sarah Smith, OCI director of public affairs.
Services Covered and Not Covered by the No Surprises Act
| No Surprises Act protects you from unexpected out-of-network bills from: | No Surprises Act does NOT protect you from: |
|---|---|
| Emergency room visits | Ground ambulance services |
| Non-emergency care related to a visit to an in-network: – Hospital – Hospital outpatient department – Ambulatory surgical center |
Vision-only and dental-only insurance |
| Air ambulance services | Short-term limited duration and health care sharing ministry plans |
Advice to Consumers
Smith urges Wisconsin residents to contact the state office for any issues related to hospital bills. The OCI also advises individuals to discuss with their insurance providers prior to any incidents to understand what’s covered and what’s not. Find the No Surprises Act complaint form here.
To learn more about the NSA, visit this page.
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