What the Law Covers
The No Surprises Act (effective January 2022) protects you from surprise bills in three situations: (1) emergency services at any facility, (2) non-emergency services at in-network facilities by out-of-network providers (like an anesthesiologist you did not choose), and (3) air ambulance services. In these situations, you pay only your in-network cost-sharing amount -- the provider and insurer must work out the rest between themselves.
Emergency Services
For emergency care, you are protected at any emergency room or freestanding emergency facility, regardless of whether it is in your insurance network. You pay your in-network deductible, copay, and coinsurance. The provider cannot bill you for the difference between their charge and your in-network rate. This protection continues until you can be safely transferred to an in-network facility.
Scheduled Care at In-Network Facilities
If you schedule surgery at an in-network hospital and an out-of-network surgeon, anesthesiologist, or pathologist treats you without your advance consent, you are protected. The out-of-network provider must accept your in-network rate and cannot balance bill you. If you do consent to out-of-network care in advance (with proper notice 72 hours before), the protection may not apply.
Dispute Process
If you receive a surprise bill that should be covered by the No Surprises Act, contact your insurer and the provider, citing the NSA. If not resolved, file a complaint with the No Surprises Help Desk (1-800-985-3059) or at cms.gov/nosurprises. You can also use the independent dispute resolution (IDR) process if the provider and insurer cannot agree on the payment amount.
Frequently Asked Questions
Does the No Surprises Act apply to ground ambulances?
No. Ground ambulance services are currently excluded from the No Surprises Act. Only air ambulance services are covered. Ground ambulance billing reform is being addressed separately.
What if I already paid a surprise bill?
You may be entitled to a refund. Contact the provider and your insurer, citing the No Surprises Act. If they refuse, file a complaint with the No Surprises Help Desk.
Does this apply to people without insurance?
For uninsured and self-pay patients, the NSA requires providers to give a good faith estimate of costs before scheduled services. If the actual bill exceeds the estimate by $400+, you can dispute it through the patient-provider dispute resolution process.
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