No Surprises Act: Your Rights Against Surprise Medical Bills

The No Surprises Act, effective January 2022, protects patients from unexpected medical bills when receiving emergency care or care at in-network facilities from out-of-network providers. Understanding these protections can save you thousands of dollars.

Key Protections Under the No Surprises Act

Emergency Services

  • You cannot be charged out-of-network rates for emergency care
  • Cost-sharing must be based on in-network rates
  • Prior authorization cannot be required for emergency services

Non-Emergency Services at In-Network Facilities

  • Out-of-network providers at in-network facilities cannot balance bill you
  • Applies to: anesthesiologists, radiologists, pathologists, and other facility-based providers
  • You must receive a notice and consent form before receiving planned out-of-network care

Air Ambulance Services

  • Air ambulance providers cannot balance bill you
  • You only pay in-network cost-sharing amounts

How to Use the No Surprises Act in Appeals

If you receive a surprise bill or out-of-network denial:

  1. Check if the service falls under NSA protections
  2. Contact your insurer and cite the No Surprises Act
  3. File a complaint with CMS if the insurer doesn't comply
  4. Request the Independent Dispute Resolution (IDR) process if needed

Good Faith Estimates

For uninsured or self-pay patients:

  • Providers must give you a Good Faith Estimate before scheduled services
  • If the final bill exceeds the estimate by $400+, you can dispute it
  • The dispute process is handled through a patient-provider dispute resolution process

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Frequently Asked Questions

Does the No Surprises Act apply to all insurance plans?

The No Surprises Act applies to most private health insurance plans, including employer-sponsored plans, individual plans, and ACA marketplace plans. It does not apply to Medicare (which has its own protections) or certain grandfathered plans.

What should I do if I receive a surprise medical bill?

Contact your insurance company and cite the No Surprises Act. If the bill is for emergency services or from an out-of-network provider at an in-network facility, you should only owe in-network cost-sharing amounts. File a complaint with CMS if the issue is not resolved.

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