Your Rights & Protections Against Surprise Medical Bills for Dental Care
At Amp Orthodontics & Kids Dental, we believe in transparency and ensuring you understand your financial responsibilities before receiving treatment. Under the No Surprises Act (NSA), you are protected from unexpected medical bills in certain situations—including some dental procedures.
What is “Surprise Billing” or “Balance Billing”?
Typically, when you visit an in-network dental provider, your out-of-pocket costs are predictable and based on your insurance coverage. However, balance billing (sometimes called “surprise billing”) can occur when an out-of-network provider bills you for the difference between their full charge and what your insurance covers. This often leads to unexpectedly high bills, especially in emergency or hospital-based dental care.
How the No Surprises Act Protects Dental Patients
The NSA protects patients in the following dental care situations:
Emergency Dental Treatment in a Hospital or Surgical Center
If you require emergency oral surgery or dental care at a hospital or ambulatory surgical center, you cannot be balance billed for services received from an out-of-network provider.
You will only be responsible for the in-network cost-sharing amount (copay, coinsurance, or deductible) outlined in your insurance plan.
Certain Anesthesia or Specialist Services During Hospital-Based Dental Treatment
If your child or a special-needs patient requires general anesthesia or other hospital-based dental services at an in-network hospital or surgical center, some of the providers involved (such as anesthesiologists, radiologists, or pathologists) may be out-of-network.
In these cases, you cannot be balance billed, and your cost-sharing responsibility is limited to in-network rates.
No Requirement to Waive Your Protections
You are never required to sign away your rights under the No Surprises Act. You also have the option to choose an in-network provider whenever available.
Good Faith Estimates for Uninsured or Self-Pay Patients
If you do not have insurance or choose to self-pay for dental care, you have the right to request a Good Faith Estimate of the cost of treatment before receiving care. This estimate should include a breakdown of anticipated charges for your dental procedures.
If You Believe You Were Wrongly Billed
If you think you’ve been wrongly balance billed for a dental procedure that falls under NSA protections, you can:
Contact your insurance provider to review your Explanation of Benefits (EOB).
File a complaint with the federal surprise billing hotline at 1-800-985-3059.
Visit www.cms.gov/nosurprises/consumers for more information about your rights under federal law.
At Amp Orthodontics & Kids Dental, we are committed to clear, upfront pricing and will always work with you to maximize your insurance benefits while minimizing unexpected costs. If you have questions about your coverage or billing, please reach out to our team—we’re happy to help!