What Is the No Surprises Act? How It Protects You

Overview of the No Surprises Act

The No Surprises Act, which took effect on January 1, 2022, is federal legislation designed to protect patients from unexpected medical bills. Before this law, patients could receive devastating surprise bills when they unknowingly received care from out-of-network providers, even at in-network facilities. The law fundamentally changed the balance of power between patients, providers, and insurers.

What the No Surprises Act Covers

The law provides protection in three main scenarios. First, emergency services: if you go to an emergency room, you cannot be balance-billed by out-of-network providers, regardless of whether the facility is in your insurance network. Second, non-emergency services at in-network facilities: if you receive care at an in-network hospital, the out-of-network doctors who treat you (such as anesthesiologists, radiologists, and pathologists) cannot send you a surprise bill. Third, air ambulance services: out-of-network air ambulance providers cannot balance-bill patients.

How It Works in Practice

When you receive care in a covered situation, the out-of-network provider can only charge you the in-network cost-sharing amount (your deductible, copay, or coinsurance as if the provider were in-network). The provider and your insurance company then negotiate or go through an independent dispute resolution process to determine the payment amount. You are kept out of the middle.

Good Faith Estimates for Uninsured Patients

The No Surprises Act also requires providers to give uninsured or self-pay patients a good faith estimate of expected charges before scheduled services. If the actual bill exceeds the estimate by $400 or more, you can dispute the bill through a patient-provider dispute resolution process. This provision gives uninsured patients a powerful tool for challenging inflated charges.

How to Use the No Surprises Act

If you receive a surprise bill that you believe violates the No Surprises Act, take these steps. Contact your insurance company and ask them to reprocess the claim using in-network cost-sharing. File a complaint with the Centers for Medicare and Medicaid Services (CMS) No Surprises Help Desk at 1-800-985-3059. If you are uninsured and your bill exceeds the good faith estimate by $400 or more, initiate the patient-provider dispute resolution process.

Known Limitations

The No Surprises Act does not cover ground ambulance services (only air ambulance), does not apply if you give written consent to be treated by an out-of-network provider at least 72 hours before a scheduled procedure, and does not cover insurance plans that are not subject to federal regulation (such as some short-term plans). It also does not directly reduce the total cost of care -- it protects you from being responsible for the full out-of-network charge, but your in-network cost-sharing still applies.

State Surprise Billing Laws

Many states have their own surprise billing protections that may be stronger than the federal law. States like New York, California, Texas, and Florida had surprise billing protections before the federal act. In many cases, the stronger law (state or federal) applies. Check your state's insurance department for specific protections.

Combining the No Surprises Act with BillDelete

While the No Surprises Act provides a floor of protection, negotiation and advocacy can further reduce your bills. BillDelete letters reference the No Surprises Act where applicable and incorporate other strategies like Medicare rate comparisons and charity care applications to achieve the maximum possible reduction.