Receiving unexpected medical bills can create significant financial stress, especially when patients believe their health insurance will cover the treatment. In the United States, this situation can happen when a patient receives care from an out-of-network healthcare provider without realizing it.
To address certain unexpected medical billing practices, the federal government introduced the No Surprises Act. This law provides important billing protections for many patients with private health insurance.
The law generally protects eligible patients from certain surprise out-of-network bills, including some emergency services and specific non-emergency services received at in-network healthcare facilities.
Understanding how the No Surprises Act works can help patients recognize their rights, review medical bills, and take action if they receive a bill that may violate these protections.
What Is the No Surprises Act?
The No Surprises Act is a federal law designed to protect patients from certain unexpected medical bills associated with out-of-network healthcare services.
It was enacted as part of the Consolidated Appropriations Act, 2021, and its major patient billing protections took effect on January 1, 2022.
Before these protections, patients could sometimes receive treatment at an in-network hospital but later discover that an out-of-network physician or another healthcare provider had participated in their care.
The patient might then receive a separate bill for the difference between the provider’s charge and the amount paid by the insurance company. This is commonly known as balance billing.
The No Surprises Act limits this practice in certain situations and requires eligible out-of-network charges to be handled under applicable in-network cost-sharing rules.
What Is a Surprise Medical Bill?
A surprise medical bill is an unexpected healthcare charge that a patient receives after treatment, often because an out-of-network provider was involved in the care.
For example, imagine that you visit an in-network hospital for surgery. Your surgeon and hospital may participate in your insurance network, but the anesthesiologist providing services during the operation may be out of network.
You might later receive a separate bill from that anesthesiologist.
Before the No Surprises Act, patients in some situations could be responsible for substantial out-of-network charges.
The law now provides protections against certain surprise bills, although not every out-of-network medical service is covered.
How Does the No Surprises Act Protect Patients?
The law establishes several important protections for eligible patients with private health insurance.
1. Protection Against Certain Emergency Medical Bills
One of the most important protections involves emergency medical services.
If you receive covered emergency services from an out-of-network provider or facility, the No Surprises Act generally requires your insurance company to apply the same cost-sharing rules that would apply to comparable in-network emergency services.
This means eligible patients generally cannot be charged more simply because the emergency provider or facility is outside their insurance network.
The protections generally apply to emergency services at hospital emergency departments and certain independent freestanding emergency departments.
They also extend to certain post-stabilization services, subject to specific legal conditions and exceptions.
2. Protection at In-Network Hospitals and Facilities
Patients may receive treatment at an in-network hospital but encounter out-of-network healthcare professionals during their visit.
The No Surprises Act protects patients from certain unexpected out-of-network bills for covered services at in-network facilities.
These protections may apply to services provided by:
- Anesthesiologists
- Emergency medicine physicians
- Radiologists
- Pathologists
- Neonatologists
- Assistant surgeons
- Other covered healthcare professionals
For applicable services, patients generally pay only the in-network cost-sharing amount, even when the provider is out of network.
3. Protection During Air Ambulance Services
Air ambulance transportation can be expensive, particularly when an out-of-network company provides the service.
The No Surprises Act generally protects patients with applicable private insurance coverage from balance billing for covered out-of-network air ambulance services.
Eligible patients are generally responsible only for the in-network cost-sharing amount under their health plan.
However, federal surprise billing protections do not generally extend to ground ambulance services. Some state laws may provide additional protections for certain ground ambulance bills.
4. Clearer Information About Patient Financial Responsibility
The law includes requirements intended to help patients understand their financial responsibilities.
For example, certain healthcare providers and facilities must provide information about federal surprise billing protections.
Patients can also find information about their rights and complaint options through official government resources.
What Types of Medical Services Are Covered?
The No Surprises Act applies to specific situations rather than every out-of-network healthcare service.
Common examples include:
| Medical service | General protection |
|---|---|
| Emergency room care | Covered emergency services generally receive surprise billing protection |
| Out-of-network emergency physicians | Generally protected for covered emergency services |
| Anesthesia at an in-network hospital | Generally protected when the statutory requirements apply |
| Radiology and pathology services | Generally protected for covered services at applicable in-network facilities |
| Air ambulance services | Generally protected for covered out-of-network air ambulance transportation |
| Certain post-stabilization services | Protected when applicable legal conditions are met |
The exact protection depends on the patient’s insurance coverage, the type of service, the healthcare facility, and applicable legal requirements.
What Medical Services Are Not Fully Protected?
It is important to understand the limitations of the No Surprises Act.
The law does not eliminate every out-of-network medical bill.
1. Routine Out-of-Network Doctor Visits
If you voluntarily schedule an appointment with an out-of-network physician, the No Surprises Act generally does not prevent that provider from charging out-of-network rates.
Before booking an appointment, check whether the doctor participates in your specific insurance plan.
2. Ground Ambulance Services
Federal No Surprises Act protections generally do not cover ground ambulance transportation.
Patients may still face unexpected ground ambulance bills, although certain states and local jurisdictions have additional billing protections.
3. Certain Non-Emergency Services Outside Your Network
If you choose to receive treatment from an out-of-network provider at an out-of-network facility, the federal protections may not apply.
You should verify network participation and request cost information before receiving planned care.
4. Services Covered by Different Insurance Programs
The federal No Surprises Act protections discussed in this article primarily address patients with applicable private health insurance coverage.
Medicare, Medicaid, TRICARE, and other government healthcare programs have separate billing protections and rules.
Patients enrolled in these programs should review the protections applicable to their specific coverage.
Can a Patient Be Asked to Sign a Waiver of No Surprises Act Protections?
In certain non-emergency situations, an out-of-network provider may ask a patient to consent to receive services under different billing arrangements.
This is sometimes called notice and consent.
However, these waivers are not permitted for every service.
For example, patients generally cannot waive federal surprise billing protections for emergency services. Notice and consent exceptions also do not apply to certain ancillary services at in-network facilities, including many anesthesia, radiology, pathology, and laboratory services.
Before signing any notice and consent document, patients should:
- Read the document carefully.
- Understand which provider is out of network.
- Review the estimated charges.
- Ask whether an in-network alternative is available.
- Confirm how the waiver could affect insurance payments and personal costs.
Do not assume that signing a document is necessary for receiving all types of hospital care.
What Should You Do If You Receive a Surprise Medical Bill?
If you receive an unexpected out-of-network bill, do not immediately assume that the amount is correct.
Take the following steps.
Step 1: Review the Medical Bill
Check the provider’s name, date of service, medical procedure, and amount charged.
Determine whether the bill relates to emergency care, an in-network facility, or air ambulance transportation.
Step 2: Compare the Bill With Your Explanation of Benefits
Your insurance company generally provides an Explanation of Benefits (EOB) showing how a claim was processed.
Review the EOB to understand:
- The amount billed by the provider
- The amount allowed by the insurance plan
- The insurance payment
- Your stated patient responsibility
An EOB is not itself a bill, but it can help you identify billing differences.
Step 3: Contact Your Insurance Company
Call the number on your insurance card and explain that you believe the bill may involve protections under the No Surprises Act.
Ask whether the claim was processed using the applicable in-network cost-sharing rules.
Step 4: Contact the Healthcare Provider
Ask the provider’s billing department to review the charge.
Explain why you believe the service may qualify for federal surprise billing protection.
Request that the provider pause collection activity while the billing issue is being reviewed, if possible.
Step 5: Submit a Complaint if Necessary
If the issue remains unresolved, you can contact the federal No Surprises Help Desk.
The official contact number is:
1-800-985-3059
The Help Desk can provide information about your rights and explain where to direct your complaint.
What Is the No Surprises Help Desk?
The No Surprises Help Desk is a federal resource that helps consumers understand protections under the No Surprises Act.
Patients can contact the Help Desk if they:
- Receive a potentially protected surprise medical bill.
- Have questions about out-of-network charges.
- Need information about their federal billing rights.
- Want to understand how to report a possible violation.
The Help Desk can explain available options and direct consumers to the appropriate complaint process.
What Is the Patient-Provider Dispute Resolution Process?
The No Surprises Act also provides a dispute resolution process for certain uninsured or self-pay patients who receive a bill that is substantially higher than their Good Faith Estimate.
Generally, if the final bill from a provider or facility is at least $400 higher than that provider’s or facility’s Good Faith Estimate for the relevant services, the patient may qualify to use the federal patient-provider dispute resolution process.
This process is different from the protections against surprise out-of-network bills for insured patients.
Eligibility requirements, deadlines, and procedures apply.
Patients can find current information through the CMS No Surprises resources:
How Can Patients Avoid Unexpected Medical Bills?
Although the No Surprises Act provides important protections, patients should still take steps to understand their healthcare costs.
Consider the following precautions:
- Confirm that your hospital or healthcare facility is in your insurance network.
- Check whether your doctor participates in your specific insurance plan.
- Ask about anesthesia, laboratory, radiology, and other professional services.
- Request a cost estimate before planned treatment.
- Review insurance authorization requirements.
- Read any notice and consent document carefully.
- Keep copies of medical bills and insurance statements.
- Contact your insurer if an unexpected out-of-network charge appears.
For emergency medical conditions, do not delay necessary treatment because you are uncertain about network status.
Frequently Asked Questions
Does the No Surprises Act apply to all US hospitals?
The law’s federal surprise billing protections apply to specified services and covered healthcare arrangements. It does not mean that every hospital service or every out-of-network bill is automatically protected.
Does the No Surprises Act protect patients with private health insurance?
Yes. The law provides important protections for many people with private health insurance, including qualifying employer-sponsored and individual or family health plans.
Does the No Surprises Act cover emergency room visits?
Generally, yes. Covered emergency services provided by out-of-network providers or facilities receive important federal billing protections, subject to the law’s requirements.
Does the law cover ambulance bills?
It generally protects eligible patients from surprise bills for covered air ambulance services. Federal protections do not generally extend to ground ambulance services.
Can an out-of-network doctor still send me a bill?
An out-of-network doctor may bill you for services that are not protected by the law. However, for services covered by the No Surprises Act, balance billing is generally prohibited, and eligible patient cost-sharing is limited to the applicable in-network amount.
What happens if I sign a notice and consent form?
In certain permitted non-emergency situations, signing a valid notice and consent form may allow an out-of-network provider to bill under different arrangements. These exceptions are limited, and patients cannot waive protections for every type of service.
How do I report a violation of the No Surprises Act?
You can contact the federal No Surprises Help Desk at 1-800-985-3059 or visit the official CMS consumer website to understand your complaint options.
Final Thoughts
The No Surprises Act provides important financial protections for patients receiving certain emergency services, out-of-network care at in-network facilities, and covered air ambulance transportation.
It helps prevent patients from being held responsible for certain unexpected out-of-network charges and generally limits their cost-sharing to applicable in-network amounts.
However, the law does not cover every medical service or eliminate all out-of-network billing. Patients should understand their insurance coverage, review medical bills carefully, and contact their insurer or the No Surprises Help Desk when a charge appears inconsistent with federal protections.
Knowing your rights can help you avoid unnecessary financial stress and make more informed healthcare decisions in the United States.
Medical Disclaimer
This article is intended for general educational and informational purposes only. It does not constitute medical, financial, or legal advice. No Surprises Act protections depend on insurance coverage, the type of service, the healthcare facility, and applicable federal and state requirements. For questions about a specific medical bill or legal dispute, contact your insurance company, CMS, or a qualified legal professional.