Understanding the No Surprises Act

The No Surprises Act is a federal law that took effect in 2022, and it's one of the strongest consumer protections most people don't know they have. Here's what it actually covers.

What it protects you from

Before this law, patients could get a fully in-network procedure and still end up with a massive out-of-network bill because the anesthesiologist, radiologist, or assisting surgeon in the room happened to be out-of-network, something the patient had no way to know or control in the moment. The No Surprises Act largely ends that.

• Emergency care. You're protected from surprise out-of-network bills for emergency services, regardless of which hospital you're taken to.
• In-network facility, out-of-network provider. If you have a procedure at an in-network hospital or facility, but an individual provider involved happens to be out-of-network, you generally can't be billed the difference.
• Air ambulance transport. Out-of-network air ambulance services are covered by the same protection.

What it means practically

In covered situations, you can only be charged what you'd normally owe for in-network care, your usual copay, deductible, and coinsurance. The provider and your insurer settle the rest between themselves, not through you.

The good-faith estimate right

If you're uninsured or paying out-of-pocket, you're entitled to a written good-faith estimate of costs before receiving non-emergency care. If your final bill comes in substantially higher than that estimate, generally more than $400 above it, you can dispute the difference through a formal federal process.

What it doesn't cover

It doesn't apply to situations where you knowingly and voluntarily choose an out-of-network provider for non-emergency care and sign a consent form acknowledging the higher cost. It also doesn't cap in-network cost-sharing, your normal deductible and coinsurance still apply.

If you think you were billed in violation of it

Note the date of service, whether it was emergency care or an in-network facility, and who the out-of-network provider was. You can file a complaint with the No Surprises Help Desk at CMS, and it's exactly the kind of finding worth including in an appeal letter to the billing office directly.