No Surprises Act: what it covers, what it doesn't, and how to use it
Emergency care, out-of-network doctors at in-network facilities, air ambulances, consent forms, Good Faith Estimates and how to complain - the federal surprise billing law in plain English.
Updated:
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Since 1 January 2022, the federal No Surprises Act protects patients from many "surprise" out-of-network bills.
What it covers
Emergency services - at any ER, in or out of network, and care until you're stable. You pay only your in-network copay, coinsurance and deductible.
Non-emergency care at an in-network hospital or surgery center from out-of-network providers you didn't choose: anesthesiologists, radiologists, pathologists, neonatologists, assistant surgeons, hospitalists, lab work.
Air ambulance services.
In these cases the provider can't balance bill you - can't bill you the difference between their charge and what your plan paid.
What it doesn't cover
Ground ambulance (some states have their own protections).
Care you chose out-of-network and validly consented to in advance (the notice-and-consent exception - which can't be used for emergency care or for the ancillary providers listed above).
Short-term health plans and some other non-ACA coverage.
Uninsured or self-pay?
You're entitled to a Good Faith Estimate before scheduled care. If the final bill from a provider is $400 or more above the estimate, you can start the patient-provider dispute resolution process within 120 days of the bill.
How to use it
Compare your EOB with the bill - look for "out-of-network" on a service you didn't choose.
Write to the provider's billing office: cite the No Surprises Act, ask them to rebill at in-network cost-sharing, and ask to hold the account.
Tell your insurer too.
If they don't fix it, complain to the No Surprises Help Desk: 1-800-985-3059 (cms.gov/nosurprises) and your state insurance department.
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