Unexpected Out-of-Network Charges

The No Surprises Act

Federal law that took effect in 2022 protects patients from many surprise out-of-network bills. It is one of the strongest consumer protections in medical billing, and many patients do not know it exists.

It applies automatically. You do not have to request it, but you do need to recognize when it should apply so you can raise it.

What it covers

Emergency care. You are generally protected from surprise out-of-network billing for emergency services regardless of which facility you were taken to.
In-network facility, out-of-network provider. If you had a procedure at an in-network facility and an individual provider involved was out of network, you generally cannot be billed the difference.
Air ambulance. Out-of-network air ambulance transport is covered by the same protection.

What it means in practice

In covered situations you generally owe only what you would have owed in network: your normal copay, deductible, and coinsurance. The provider and insurer resolve the remainder between themselves.

What it does not cover

It generally does not apply when you knowingly and voluntarily chose an out-of-network provider for non-emergency care and signed a consent acknowledging the higher cost. It also does not cap your normal in-network cost sharing.

How to raise it

Note the date of service, whether the care was an emergency, whether the facility was in network, and which provider billed you. State clearly in writing that you believe the charge falls under federal surprise-billing protections and request review.

Complaints can also be filed with the federal No Surprises Help Desk.