The No Surprises Act Explained: Your Rights Against Surprise Medical Bills
Before 2022, an out-of-network anesthesiologist at an in-network hospital could legally send you a bill for thousands of dollars — even though you had no idea they were out-of-network when you went in for surgery. The No Surprises Act ended that practice. Here's what it covers and how to use it.
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What Is the No Surprises Act?
The No Surprises Act is a federal law that took effect January 1, 2022. It protects patients from receiving unexpected bills from out-of-network providers in situations where they had no realistic choice — like emergency care or when an out-of-network provider is brought in at an in-network facility without the patient's knowledge.
Under this law, if you receive care covered by the Act, you can only be charged your in-network cost-sharing amount (your deductible, copay, or coinsurance) — not the full out-of-network rate.
What the No Surprises Act Covers
Emergency care at any facility
If you go to an emergency room — in-network or out-of-network — you can only be charged your in-network cost-sharing amount for emergency services, regardless of whether the ER is in your network.
Out-of-network providers at in-network facilities
If you're treated at an in-network hospital but an out-of-network doctor, anesthesiologist, radiologist, or lab performs services, you cannot be balance-billed for those services.
Air ambulance services (from participating insurers)
Out-of-network air ambulance bills are now subject to the same protections as emergency care for most employer-sponsored and individual plans.
What It Doesn't Cover
The No Surprises Act has limits. It does not apply to:
Planned out-of-network care you chose and consented to in advance (with a signed notice)
Ground ambulance services (this is a known gap in the law)
Medicare and Medicaid (these have separate rules)
Short-term health plans and some grandfathered plans
The Consent Exception — Read This Carefully
Providers can get around the No Surprises Act if they give you written notice at least 72 hours before the service and you sign a consent form agreeing to out-of-network billing. This is a major loophole that some providers exploit.
If you're asked to sign any documents before a non-emergency procedure, read them carefully. If any form mentions out-of-network billing or waiving your surprise billing protections, you have the right to refuse and request an in-network provider instead.
What to Do If You Receive a Surprise Bill
Don't pay it immediately
Paying the bill may be interpreted as accepting the charges. First verify whether the No Surprises Act applies to your situation.
Contact your insurer
Call the member services number on your insurance card and explain you received an out-of-network bill for emergency care or care at an in-network facility. Ask if the No Surprises Act protects you.
File a complaint
If your insurer confirms you're protected but the provider won't back down, file a complaint at CMS.gov or call 1-800-985-3059. Providers who violate the No Surprises Act face civil penalties.
Scan the bill for other errors
Surprise billing protection aside, the bill itself may still contain overcharges, duplicate charges, or incorrect codes. Always check.
Check your bill for violations and errors
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