The No Surprises Act: Your Federal Protection Against Surprise Medical Bills

The No Surprises Act is a federal law that took effect on January 1, 2022. It protects patients with private health insurance from receiving surprise medical bills in certain situations — specifically, emergency services at out-of-network facilities, non-emergency services provided by out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers. Before this law, patients could receive bills for thousands or even tens of thousands of dollars when they unknowingly received care from an out-of-network provider. The No Surprises Act shifts the financial dispute to the provider and the insurance company, keeping the patient out of the middle.

The No Surprises Act applies in three main scenarios: 1. Emergency services: All emergency care must be billed at in-network rates, regardless of whether the facility or provider is in your insurance network. This includes emergency room visits, stabilization, and post-stabilization care. 2. Non-emergency services at in-network facilities: If you go to an in-network hospital but are treated by an out-of-network doctor (such as an anesthesiologist, radiologist, or pathologist), you cannot be balance billed for the difference. 3. Air ambulance services: Out-of-network air ambulance providers cannot balance bill you beyond your in-network cost-sharing amount. The law applies to most private health insurance plans, including employer-sponsored plans, marketplace plans, and individual plans. It does not apply to Medicare, Medicaid, Indian Health Service, Veterans Affairs, or TRICARE (these programs have their own protections).

Under the No Surprises Act, you have the right to: - Receive a good faith estimate of charges before scheduled services if you are uninsured or self-pay - Dispute bills that exceed your good faith estimate by $400 or more through an independent dispute resolution process - Not be balance billed for covered emergency services - Not be balance billed by out-of-network providers at in-network facilities without your prior written consent - Receive clear notice of your rights at the time of scheduling and at the point of care - File a complaint if a provider violates the law

If you believe a provider has violated the No Surprises Act, you can file a complaint through the federal government's portal at cms.gov/nosurprises or by calling 1-800-985-3059. You can also file a complaint with your state insurance department. Complaints should include the provider's name and contact information, the date of service, a copy of the bill showing the surprise charge, your insurance information, and a description of what happened. The Centers for Medicare and Medicaid Services (CMS) investigates complaints and can impose penalties on providers who violate the law.

The No Surprises Act has some important limitations: - It does not apply to ground ambulance services (only air ambulance) - Providers can ask you to waive your protections for non-emergency services, but they must provide written notice 72 hours in advance and obtain your written consent - It does not cap what providers can charge — it only determines who pays (the insurer vs. the patient) - It does not apply to services not covered by your insurance plan - Short-term or limited-duration health plans may not be fully covered Even with these limitations, the No Surprises Act provides significant protection for the majority of privately insured Americans.