The No Surprises Act: Federal Protection from Surprise Bills
What does the No Surprises Act protect me from?
The No Surprises Act makes it illegal for out-of-network providers to balance bill you for emergency services or non-emergency care at in-network facilities. If you receive a surprise bill in these situations, do not pay it — call the provider citing the No Surprises Act and file a complaint at 1-800-985-3059.
For years, one of the most feared and unfair medical billing practices was the surprise out-of-network bill. This would happen when a patient went to an in-network hospital but was unknowingly treated by an out-of-network doctor. The patient would then receive a massive bill for the full, undiscounted amount. Thankfully, a federal law called the No Surprises Act, which went into effect in 2022, has made this practice illegal in most situations.
What is a Surprise Out-of-Network Bill?
A surprise bill occurs when you receive care from a provider that is not in your insurance company's network, but you had no reasonable way of knowing it.
Classic Example
You go to an in-network hospital for emergency surgery. You carefully choose an in-network surgeon. However, the anesthesiologist who is assigned to your case is out-of-network.
Before the No Surprises Act: That anesthesiologist could bill you for their full, undiscounted charge—potentially thousands of dollars more than what your insurance would cover at in-network rates. This practice is called balance billing.
After the No Surprises Act: This is now illegal. The anesthesiologist must bill you at in-network rates.
Your Rights Under the No Surprises Act
The No Surprises Act protects you from surprise out-of-network bills in three key situations:
1. Emergency Services
If you receive care at an out-of-network emergency room, you can only be charged your normal in-network cost-sharing (your deductible, copay, and coinsurance).
This applies whether the emergency room is in-network or out-of-network, and regardless of whether you had time to choose the facility.
2. Non-Emergency Services at In-Network Facilities
If you have a planned procedure at an in-network hospital or surgery center, all of the providers who treat you there (like the anesthesiologist, radiologist, pathologist, or assistant surgeon) are considered in-network for billing purposes.
They cannot send you a separate, out-of-network bill, even if they are not in your insurance network.
3. Air Ambulance Services
You are protected from surprise bills from out-of-network air ambulance (helicopter or plane) services.
Important Exception: The law does NOT apply to ground ambulance services. You can still receive a surprise bill from a ground ambulance.
What This Means for You
In these protected situations, you are only responsible for your normal in-network costs. The out-of-network provider and your insurance company must negotiate the payment between themselves through a new federal arbitration process. They are not allowed to put you in the middle.
What to Do If You Get a Surprise Bill
Step-by-Step Action Plan
- 1.Compare Your Bill to Your EOB: Look at your Explanation of Benefits (EOB) from your insurance company. It should show the service as being processed at your in-network rate. If the bill you receive from the provider is for more than the "patient responsibility" listed on the EOB, it is a potential violation of the No Surprises Act.
- 2.Call the Provider's Billing Office: Call the billing office of the provider who sent you the bill. Inform them that you believe this bill is a violation of the No Surprises Act. Say: "I am protected from this surprise bill under the No Surprises Act. You are required to treat this as an in-network claim. Please send me a corrected bill for my in-network cost-sharing amount only."
- 3.Call Your Insurance Company: If the provider is not cooperative, call your insurance company. They have a legal responsibility to enforce the No Surprises Act and to protect you from these illegal bills.
- 4.File a Federal Complaint: If you are still not able to resolve the issue, you can file a formal complaint with the U.S. Department of Health and Human Services through their No Surprises Help Desk: cms.gov/nosurprises/consumers
- 5.Do NOT Pay the Bill: Do not pay a bill you believe violates the No Surprises Act. Paying it may waive your right to dispute it later.
Important Exceptions and Limitations
You Chose an Out-of-Network Provider
If you knowingly and voluntarily choose to see an out-of-network provider for non-emergency care, and you sign a written consent form acknowledging the out-of-network charges, the No Surprises Act does NOT protect you.
The consent form must include a good faith estimate of the charges.
Ground Ambulances
The No Surprises Act does NOT cover ground ambulance services. This is a major gap in the law. You can still receive surprise bills from ground ambulance companies.
Post-Stabilization Services
If you are stabilized after emergency care at an out-of-network facility and are able to consent, you may be asked to sign a consent form for continued out-of-network care. Read carefully before signing.
Federal Resources
No Surprises Help Desk
The federal government has established a help desk to answer questions and receive complaints about surprise billing.
Phone: 1-800-985-3059
Website: cms.gov/nosurprises/consumers
State Insurance Departments
Many states have additional surprise billing protections beyond the federal law. Contact your state insurance department for information.
File complaints with both federal and state agencies for maximum protection.
Related Resources
Balance Billing
Understand when balance billing is illegal and how to fight it.
How to Read an EOB
Learn to decode your EOB to identify surprise billing violations.
Billing Disputes
Complete guide to disputing surprise bills and other billing errors.
Insurance Mix-Ups
Fix insurance processing errors that can lead to incorrect bills.