The No Surprises Act: Your Protection Against Surprise Medical Bills

The No Surprises Act became effective January 1, 2022, protecting patients from surprise medical bills. It limits what you pay for out-of-network care in emergency situations and at in-network facilities when you don't have the opportunity to choose your provider.

The law protects you for emergency services at any facility (in or out of network), out-of-network providers at in-network facilities (like an out-of-network anesthesiologist), and air ambulance services from out-of-network providers. Ground ambulances are not covered.

For protected services, you only pay in-network cost-sharing amounts. This means your deductible, copay, and coinsurance are calculated as if the provider was in-network. The provider cannot bill you for the difference (balance billing).

If you're uninsured or paying out-of-pocket, providers must give you a Good Faith Estimate of expected charges before scheduled services. If the actual bill exceeds the estimate by $400 or more, you can dispute it through a federal process.

If you receive a surprise bill, contact your insurance first, then file a complaint with CMS (Centers for Medicare & Medicaid Services). For Good Faith Estimate disputes, use the federal patient-provider dispute resolution process within 120 days.

The law does not apply if you voluntarily choose an out-of-network provider and sign a consent form giving up your protections. Read all forms carefully before signing. You cannot be required to waive protections for emergency care.