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No Surprises Act - What It Covers and How to Use It

The No Surprises Act (effective January 1, 2022) protects you from unexpected out-of-network charges in specific situations. If you received a surprise bill, you likely have rights.

Who Is Protected

The Act applies to most people with private health insurance (employer plans, marketplace plans, individual plans). It does not apply to people on Medicare, Medicaid, TRICARE, VA, or Indian Health Service — those programs have their own protections.

The Act also does not cover ground ambulance, out-of-network care you knowingly chose, or post-stabilization services where you gave written consent to go out-of-network.

Emergency Services

Scenario

You went to the ER or were admitted as an emergency, and some providers were out-of-network.

Your protection

You can only be charged your in-network copay, coinsurance, and deductible. The provider cannot send you a balance bill for the difference between their charges and what insurance paid.

Your rights

  • In-network cost-sharing only, regardless of provider network status
  • No balance billing from out-of-network ER doctors, anesthesiologists, or other providers
  • 30-day window to dispute any prohibited balance bill
  • Right to request a Good Faith Estimate before non-emergency services

What to do

  1. Review your bill to confirm in-network cost-sharing was applied
  2. Contact the billing department if you believe a balance bill was sent in error
  3. Verify with your insurance what your actual cost-sharing should be
  4. The CMS No Surprises Help Desk (1-800-985-3059) can answer questions about your protections
  5. Keep copies of EOBs, bills, and any correspondence for your records

Out-of-Network Providers at In-Network Facilities

Scenario

You went to an in-network hospital, but were treated by an out-of-network doctor you didn't choose — such as an anesthesiologist, radiologist, or pathologist.

Your protection

The out-of-network provider can only charge you in-network rates. You must give explicit written consent to waive this protection, and emergency services can never require consent to waive.

Your rights

  • Out-of-network providers at in-network facilities must charge in-network rates
  • Written consent required before any waiver of protections
  • Emergency services cannot require consent to waive
  • Right to file a complaint with HHS if rights are violated

What to do

  1. Review your EOB to confirm what your insurance paid
  2. Contact the billing department if the amount exceeds your in-network cost-sharing
  3. Reference the No Surprises Act when discussing the bill
  4. The CMS No Surprises Help Desk (1-800-985-3059) can assist if you have questions
  5. Keep documentation of all bills and communications

Air Ambulance Transport

Scenario

You were transported by air ambulance (helicopter or fixed-wing) and the air ambulance provider was out-of-network.

Your protection

Your cost-sharing is limited to in-network amounts. The air ambulance provider cannot balance bill you for the difference.

Your rights

  • Air ambulance cost-sharing limited to in-network amounts
  • No balance billing for emergency air ambulance transport

What to do

  1. Verify the air ambulance was medically necessary (required for protections to apply)
  2. Review your EOB for the allowed amount
  3. Contact the billing department if you received a balance bill — the NSA limits cost-sharing to in-network amounts
Important: Ground ambulance is NOT covered under the No Surprises Act. If you were transported by ground ambulance, these protections do not apply.

Good Faith Estimates

Under the No Surprises Act, you can request a Good Faith Estimate before receiving non-emergency services. This is especially useful if you're uninsured or paying out of pocket.

The provider must give you an estimate of expected charges. If the final bill exceeds the estimate by $400 or more, you can dispute it through the patient-provider dispute resolution process.

Where to Get Help

If you have questions about whether the No Surprises Act applies to your situation:

  1. Call the No Surprises Help Desk at 1-800-985-3059
  2. Visit cms.gov/nosurprises for official guidance and resources
  3. Contact your state insurance department — many states have additional patient protections

Got a bill you're not sure about?

Upload it and check line items against Medicare benchmarks. The analyzer flags potential issues including out-of-network charges.

Open Bill Analyzer

Related resources

Bill Analyzer
Upload a bill and compare charges to Medicare rates
Why Multiple Bills?
Understanding separate bills from one visit
Financial Assistance Finder
Check if you qualify for charity care
Insurance Appeal Rights
How to appeal a denied claim

Based on the No Surprises Act (Public Law 116-260, Division BB, Title I), effective January 1, 2022.

This is general guidance, not legal advice. Consult a patient advocate or legal professional for advice specific to your situation.