Blog, Education, Insurance
April 8, 2024

NSA Notice and Consent Form

2 minute read
Blog Notice and Consent Form (2)

IMPORTANT NOTICE: Do Not Consent to Being Balance-Billed

Stay protected from surprise medical bills! The No Surprises Act shields patients from balance billing but watch out for exceptions. Don’t waive your protection from NSA or consent to balance billing for non-emergency or emergency care and review all documents carefully.

Are you aware of the hidden risks inside the No Surprises Act? The No Surprises Act provides consumers protection from provider balance billing for emergency, air ambulance, and certain out-of-network services.  While it offers consumers protection, some providers are using exceptions that allow them to balance bill participants for certain services.

Exceptions and how to navigate them

  1. Understanding the No Surprises Act: The No Surprises Act protects people covered under group and individual health plans from receiving surprise medical bills. This includes most emergency services, non-emergency services from out-of-network providers at in-network facilities, and services from out-of-network air ambulance service providers.
  2. The Exception: Despite the NSA’s protective measures, certain providers use exceptions in the law to balance bill participants for specific services. For instance, if a participant schedules non-emergency care at a contracted healthcare facility, with an out-of-network  provider, the provider may request the participant’s consent to balance billing.
  3. The 72-Hour Rule: the 72-hour rule mandates that a request must be made at least 72 hours before the date of service.
  4. Standard Notice and Consent Documents: The consumer will encounter the following or similar forms: Standard Notice and Consent Documents Under the No Surprises Act (
  5. Post-Emergency Waiver Requests: Be aware of the possibility that a provider may make a waiver request following stabilization after an emergency. If the attending emergency physician or treating provider determines that a participant is stable enough to travel using nonmedical or nonemergency medical transport to an available health care facility within a reasonable travel distance, waiver requests can be provided.

Protecting Participants: Guidance on Avoiding Balance Billing and Waiving NSA Protections

Instruct your participants not to waive the protections from the NSA or consent to be balance billed. Participants should carefully review all documents provided to them for signature in connection with medical services and not sign anything they are uncomfortable with.

By understanding the nuances of the No Surprises Act and being proactive in reviewing all documents related to medical services, your participants can safeguard against surprise balance billing. Don’t hesitate to reach out for support and guidance in protecting your plan participants.

For more information, please contact


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