The No Surprises Act is a federal law that took effect January 1, 2022, and it protects you from surprise medical bills in specific situations. Before this law, you could receive care at an in-network hospital but get a separate bill for thousands of dollars from an out-of-network doctor who happened to be on staff that day. That's now illegal in most circumstances.
What it covers:
Emergency services: All emergency care must be billed at in-network rates regardless of whether the facility or providers are in your insurance network. This applies to hospital emergency rooms and freestanding emergency facilities. You can't be balance-billed for emergency care.
Out-of-network providers at in-network facilities: If you go to a hospital that's in your network but are treated by an out-of-network anesthesiologist, radiologist, pathologist, or other specialist, those providers can only charge you your in-network cost-sharing amount. The balance is between the provider and your insurance company, not you.
Air ambulance services: Out-of-network air ambulance providers can only charge you the in-network rate. Ground ambulance services are not covered by this law (that's a gap Congress is still working on).
What it doesn't cover:
The law does not apply if you knowingly choose an out-of-network provider and sign a consent form waiving your protections. Some facilities will ask you to do this. You can refuse. The law also doesn't cover ground ambulances, post-stabilization care if you agree to be transferred to an out-of-network facility, or people on Medicare (who already have similar protections) or those who are uninsured.
Good Faith Estimates for uninsured patients: If you don't have insurance, the No Surprises Act requires providers to give you a Good Faith Estimate of costs before scheduled care. If the final bill exceeds the estimate by $400 or more, you can dispute it through a patient-provider dispute resolution process.
How to use it: If you get a surprise bill that you think violates this law, contact the No Surprises Help Desk at 1-800-985-3059. You can also file a complaint at cms.gov/nosurprises. The provider or facility can face penalties for violations.
Keep every Explanation of Benefits (EOB) from your insurance company. If you're billed for more than what your EOB shows as your patient responsibility, that's your first signal that something may be wrong and the No Surprises Act may apply.