No Surprises Act Cost-Share (QPA-Based)
No Surprises Act cost-share: the protected patient cost-share on the QPA and the prohibited balance-bill amount for an emergency/out-of-network claim.
Open the tool → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Service category under the No Surprises Act
- Protected: emergency service
- Qualifying Payment Amount
- 800 $
- Billed charge
- 1000 $
- In-network coinsurance percentage
- 20
Result: Protected emergency: patient cost-share $160.00 (20% of the $800.00 QPA); plan pays $640.00; $200.00 balance bill prohibited.
The tool opens with these values already filled in. Replace them with your own.
What you enter
- Service category under the No Surprises Act
- Qualifying Payment Amount (QPA)
- Billed charge (for the prohibited balance-bill amount)
- In-network coinsurance percentage
How this is calculated
No Surprises Act (PHS Act §2799A-1/§2799A-2; 45 CFR Part 149): for protected out-of-network emergency and certain ancillary services at in-network facilities, the patient cost-share is computed as if in-network off the QPA, and balance billing is prohibited. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.
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