No Surprises Act: Your Protection Against Surprise Medical Bills

Before 2022, you could go to an in-network hospital, get treated by a doctor you didn't choose, and receive a massive bill because that doctor was out-of-network. These "surprise bills" could run into tens of thousands of dollars.

The No Surprises Act, which took effect January 1, 2022, largely ended this practice. Here's what you need to know to protect yourself.

What the No Surprises Act Covers

You're protected from surprise out-of-network bills for:

• Emergency services: Any ER visit, regardless of whether the hospital is in-network

• Air ambulance services: From out-of-network providers

• Non-emergency services at in-network facilities: When you can't choose your provider (anesthesiologists, radiologists, pathologists, etc.)

How the Protection Works

When you're protected by the Act:

• You only pay what you would have paid for in-network care (your normal copay, coinsurance, and deductible)

• The out-of-network provider cannot "balance bill" you for the difference

• Disputes about payment are settled between the provider and insurance company, not involving you

When You're NOT Protected

The Act doesn't cover:

• Ground ambulances (a significant gap, still working on legislation)

• Services where you signed a consent waiver acknowledging out-of-network costs

• Facilities you chose that are out-of-network (if you knowingly went there)

• Post-stabilization care if you could have been transferred but chose to stay

How to Use Your Rights

1. Know before you go: When scheduling a procedure, ask if all providers involved are in-network

2. Don't sign waivers without reading: Some providers try to get you to waive your protections

3. Review bills carefully: If you receive a surprise bill, don't pay it immediately

4. Dispute improper charges: Contact your insurance and the provider's billing department

What to Do If You Get a Surprise Bill

1. Call your insurance company to confirm the service should have been covered at in-network rates

2. Contact the provider's billing department and cite the No Surprises Act

3. File a complaint with CMS if the provider won't comply: 1-800-985-3059

4. Contact your state's insurance commissioner if needed

Good Faith Estimates for Uninsured Patients

The Act also requires providers to give uninsured patients a "Good Faith Estimate" of costs before scheduled services. If your actual bill is $400+ higher than the estimate, you can dispute it.

The No Surprises Act represents a major win for patients. Know your rights and don't hesitate to use them.