In January 2022, the No Surprises Act took effect in the United States, a law designed to shield patients from unexpected out-of-network bills at in-network facilities. It was heralded as a major win for patients. But there are significant gaps in the law that could still leave you on the hook for a massive bill.
What the Law Actually Protects You From
The No Surprises Act bans out-of-network surprise bills in two main scenarios:
- Emergency care at any facility, regardless of network status
- Non-emergency care by out-of-network providers at in-network facilities (e.g., an out-of-network anesthesiologist at your in-network hospital), when you had no realistic choice
In these cases, your cost-sharing (copay, deductible, coinsurance) must be calculated as if the provider were in-network.
The Loopholes
- Air ambulances: partially covered, but ground ambulances are fully exempt from the law
- Facilities that are entirely out-of-network: the law does not apply if the whole hospital is out-of-network, only if you received out-of-network care at an in-network facility
- Consent forms: if you sign a consent form acknowledging and accepting out-of-network charges, the surprise billing protections do not apply, even if you felt pressured
- Non-emergency elective procedures: you can be balance-billed for non-emergency services with advance notice
What to Do If You Receive a Surprise Bill
If you believe the law applies to your situation and you've received a surprise bill, dispute it in writing immediately. Reference the No Surprises Act by name. Contact your insurer's member advocacy line, they have a legal obligation to help resolve these disputes. If that fails, contact the federal No Surprises Help Desk at 1-800-985-3059.