Unexpected medical bills can be stressful, confusing and financially overwhelming, especially when patients have little control over who provides their care. The No Surprises Act was designed to protect patients from these surprise bills.
When medical emergencies arise and patients receive care at an in-network hospital from an out-of-network provider, the No Surprises Act limits what patients can be charged and increases transparency around healthcare costs. In this post, we break down what the Act is, how it works, the benefits it provides, and what patients should do if they receive an unexpected medical bill.
What is the No Surprises Act?
The No Surprises Act is a federal law designed to protect patients from unexpected medical bills in situations where they have little or no control over who provides their care. The law went into effect in January 2022, and it applies to so-called “surprise billing” under most private health insurance plans, which occurs when patients unknowingly receive care from out-of-network providers.
These protections apply in emergency situations and in certain nonemergency cases, such as when a patient seeks care at an in-network hospital but is treated by an out-of-network provider without their knowledge:
- Emergencies: In an emergency, patients are expected to go to the nearest available emergency room, which may or may not be in their health plan’s network. Additionally, some providers working in that facility may be out of network, even if the hospital itself is in network.
- Nonemergency situations: Patients may receive care from out-of-network providers at an in-network hospital, such as an anesthesiologist or radiologist who does not participate in their insurance network. In some cases, patients may never directly interact with these providers.
Before the No Surprises Act went into effect, in those scenarios, it was not unusual for patients to receive an unexpected bill for the care they unknowingly received from a medical provider who wasn’t in their insurance plan’s network.
The Benefits of the No Surprises Act
The No Surprises Act offers important protection for patients by preventing unexpected bills in certain healthcare situations. Under the law, out-of-network providers are not allowed to send surprise bills for emergency care or for out-of-network services delivered at an in-network hospital. Instead, patients can only be charged their regular in-network amounts, such as copays or deductibles. If the care is covered under the patient’s health plan, it must be billed to the patient as if it were in network, even when provided by an out-of-network clinician.
In addition to limiting surprise charges, the law improves transparency and reduces financial stress for patients. Health plan ID cards are required to clearly display in-network deductibles and out-of-pocket maximums, making cost information easier to access. By requiring clearer cost estimates and limiting patient responsibility to in-network amounts, the law helps patients avoid hidden costs and feel more confident seeking needed medical care.
How to Handle a Surprise Charge
If you receive a surprise medical bill, it’s important to first understand the exceptions to the No Surprises Act. The law does not apply to ground ambulance services, which remain a significant source of surprise billing. It also does not protect patients who knowingly choose to receive care from an out-of-network provider in a nonemergency. If a patient visits an out-of-network doctor or facility by choice, standard out-of-network billing rules apply, and billing may still occur. In addition, the No Surprises Act does not apply to Medicare, Medicaid, Veterans Affairs or the Indian Health Services, as these programs already have existing protections against unexpected medical bills.
If you believe you received a surprise medical bill that should be covered under the No Surprises Act, you should contact the provider that sent the bill as your first step. Let them know you believe the charges fall under the Act’s protections. The provider should instruct you to disregard the additional out-of-network charges and begin the dispute resolution process directly with your health plan. Under the law, patients should not be placed in the middle of billing disputes between providers and insurers, allowing you to focus on your care rather than unexpected costs.
It’s important to note that these consumer protections are only available if your medical plan is subject to the No Surprises Act. For example, the Act does not apply to short-term health insurance plans. Additionally, if you are uninsured or self-pay and receive a bill that is significantly higher than the good faith estimate you were given, the law provides access to a dispute resolution process to address the difference.
If you need additional help in getting the bill redirected, you can reach out to:
- Your state department of insurance: For state-regulated health coverage
- The U.S. Department of Labor: For self-insured group health plans
Where to find more information
- Centers for Medicare & Medicaid Services (CMS) provides detailed explanations, patient rights and complaint processes.
- HealthCare.Gov and LegalClarity offer consumer-friendly guidance on how the law works and when protections apply.
- Your insurance provider’s website often includes plan-specific details and examples of coverage under the law.
The No Surprises Act represents a major step forward in protecting patients from unexpected and unfair medical bills. By limiting surprise billing and ensuring patients are only responsible for in-network cost-sharing amounts in certain situations, the law helps reduce financial stress and promote transparency in healthcare, and understanding when the law applies empowers patients to act if they receive an unexpected bill.
If something doesn’t seem right, patients should reach out to their provider or insurer and use trusted resources to understand and enforce their rights. Staying informed is the best defense against surprise medical costs.