Surprise Medical Bills: Your Rights Under the No Surprises Act

Before 2022, you could go to an in-network hospital and still get a massive bill from an out-of-network anesthesiologist, radiologist, or other provider you never chose. The No Surprises Act, signed in December 2020 and effective January 1, 2022, put an end to most of these situations.

What the Law Covers

Emergency services: All emergency care must be treated as in-network regardless of where you go. The hospital can't require prior authorization and can't charge you more than in-network rates. This applies even if the ER or the doctors treating you are out of network.

Out-of-network providers at in-network facilities: If you go to an in-network hospital and get treated by an out-of-network provider you didn't choose (anesthesiologists, assistant surgeons, radiologists, pathologists), you can only be charged in-network rates. The provider and your insurer work out the rest between themselves.

Air ambulance services: Out-of-network air ambulance charges are limited to in-network cost-sharing amounts.

Good Faith Estimates for the Uninsured

If you're uninsured or paying out of pocket, providers must give you a good faith estimate of costs before scheduled services. If the final bill exceeds the estimate by $400 or more, you can dispute it through a patient-provider dispute resolution process.

What It Doesn't Cover

The law doesn't apply if you voluntarily choose an out-of-network provider and sign a consent waiver. It doesn't cover ground ambulances (only air). And it doesn't apply to people on traditional Medicare (though Medicare has its own protections). The law covers group and individual health plans, including employer and marketplace plans.

How to Use Your Rights

If you get a surprise bill that you think violates the law, call your insurer and the provider. File a complaint with CMS at cms.gov/nosurprises. You can also call 1-800-985-3059 for help. Keep copies of all bills, EOBs, and communications.