Nevada provides strong balance billing protections through both state law and the federal No Surprises Act. Understanding these protections helps you dispute unexpected out-of-network charges effectively.
Nevada SB 259 (2021) Surprise Billing Protection Act
Nevada SB 259, effective January 1, 2022, enacted the Nevada Surprise Billing Protection Act codified in NRS Chapter 689C. This comprehensive state law covers balance billing for emergency services and scheduled non-emergency services at in-network facilities.
In-Network Cost-Sharing Only
Under Nevada SB 259, patients are responsible only for in-network cost-sharing amounts. Out-of-network providers must bill the insurer for the remaining balance—they cannot collect excess amounts from patients.
Nevada Division of Insurance Enforcement
The Nevada Division of Insurance enforces NRS Chapter 689C. Violations may result in fines up to 5,000 dollars per violation, plus any refunds owed to patients. The DOI also conducts market conduct reviews of pattern violations.
Federal No Surprises Act Concurrent Application
The federal No Surprises Act, effective January 1, 2022, applies concurrently with Nevada SB 259. When both state and federal rules apply, the greater protection for the patient applies.
ERISA Plan Coverage
Nevada's SB 259 applies to state-regulated health plans. ERISA self-insured plans are subject to the federal No Surprises Act. Identifying your plan type determines which rules apply and where to file complaints.
How to Dispute Balance Bill Under Nevada Law
- Confirm the service qualifies under Nevada SB 259 or NSA (emergency or scheduled at in-network facility).
- Contact the health plan in writing citing Nevada SB 259 and federal No Surprises Act.
- Request an in-network rate adjustment with supporting documentation of the balance bill.
- File a Nevada DOI complaint if the plan refuses to adjust within 30 days.
Altair identifies Nevada balance billing violations and enforces your rights across all plan types.
Frequently Asked Questions
What does Nevada SB 259 cover?
Nevada SB 259 covers balance billing for emergency services at any facility and scheduled non-emergency services at in-network facilities when out-of-network providers are involved. Patients pay only in-network cost-sharing.
Does Nevada's balance billing law apply to ERISA plans?
No, Nevada SB 259 applies only to state-regulated health plans. ERISA self-insured plans are subject to the federal No Surprises Act instead. The federal law often provides equivalent or greater protection.
What penalties do Nevada insurers face for balance billing violations?
Nevada law imposes fines up to 5,000 dollars per violation of SB 259. Insurers must also refund any amounts collected from patients in violation of the law.
Related Nevada Insurance Topics
- Nevada Timely Filing Requirements
- Nevada Surprise Billing Protections
- Nevada Prior Authorization Rules
- All State Billing Laws
- Federal No Surprises Act