The No Surprises Act Protects You
Federal law protects you from unexpected medical bills after emergencies and from out-of-network providers at in-network facilities.
Understanding the Problem
What is Surprise Billing?
Surprise billing affects millions of Americans every year — especially after emergencies.
Have you ever visited the emergency room, only to receive a bill you did not expect? Had surgery at an in-network facility covered by your health plan, only to receive an unexpected bill from an out-of-network anesthesiologist? Or been injured in an accident and received a surprise bill for the air ambulance ride to the hospital?
Surprise billing occurs when you have health coverage and unknowingly or unavoidably receive care from an out-of-network provider or at an out-of-network healthcare facility — and are billed directly for that care when your health plan does not cover the entire cost.
In the past, out-of-network providers could bill you for the difference between their billed charge and the amount your health plan would pay (called “balance billing”). For example, if a provider charged $1,000 and your plan’s allowed amount was $250, you could be billed the remaining $750 — on top of any cost-sharing you already owed.
In-Network Provider
A healthcare provider or facility that has a contract with your group health plan or health insurance issuer to provide services to members at certain negotiated costs.
Out-of-Network Provider
A healthcare provider or facility that does not have a contract with your health plan. May also be called a “non-preferred provider” or “non-participating provider.”
What the Law Covers
New protections under the No Surprises Act
The federal No Surprises Act was enacted to protect you from these surprise bills and reduce healthcare costs.
Emergency Services
Most emergency services, including emergency mental health services, even when provided by an out-of-network provider or facility without prior authorization.
Out-of-Network Providers at In-Network Facilities
Non-emergency services from out-of-network providers at in-network hospitals, hospital outpatient departments, or ambulatory surgical centers.
Air Ambulance Services
Services from out-of-network air ambulance service providers are protected if your plan covers air ambulance services at all.
What the No Surprises Act does
Bans surprise bills in most emergencies, even when treatment is provided outside of your plan's network and without prior authorization.
Limits cost-sharing for most emergency services and non-emergency services provided at an in-network facility by an out-of-network provider.
Requires patient consent to waive surprise billing protections for certain non-emergency circumstances.
Bans out-of-network ancillary providers (anesthesiology, pathology, radiology, neonatology) from balance billing patients at in-network facilities.
Requires that providers and facilities give you a notice explaining billing protections and who to contact if protections are violated.
Eligibility
Does this apply to me?
Most people with health coverage are protected — but there are some exceptions.
You ARE covered if you have:
A health plan through your employer
A health plan you purchased yourself through the marketplace or directly from an insurer
Most private health insurance plans
The law does NOT apply to:
Short-term, limited-duration insurance plans
Excepted benefits plans (such as standalone dental and vision coverage)
Retiree-only plans
Account-based group health plans
Non-emergency services at out-of-network facilities
Services and treatments not covered by your plan
Payments count toward your deductible
A plan cannot require more cost-sharing for out-of-network emergency services, non-emergency services at an in-network facility, or air ambulance services than it does for equivalent in-network services. Any cost-sharing payments you make must count toward your in-network deductible or out-of-pocket maximums as if an in-network provider charged them.
Real Scenarios
See the law in action
Here is how the No Surprises Act protects you in common situations.
Emergency Room Visit
Scenario: While walking your dog, you slip on ice, hit your head, and break your arm, requiring you to visit the nearest emergency room. The doctor orders imaging, radiology, and determines that the severity of the injury requires same-day surgery.
Protected: Even if you received this emergency care from an out-of-network provider or facility, you are only responsible for paying your in-network deductible, copayments, and coinsurance.
In-Network Facility, Out-of-Network Ancillaries
Scenario: You schedule a surgical biopsy at an in-network hospital with an in-network surgeon. You do not know if the providers administering your anesthesia and examining the tissue are also in-network.
Protected: Ancillary out-of-network expenses will be at the in-network rate if your healthcare facility is in-network — this includes anesthesiologists and pathologists.
Air Ambulance Transport
Scenario: During an intense exercise session, you experience sharp chest pains. Following a brief exam, the doctor determines you must be transported by air ambulance to a hospital specializing in cardiology.
Protected: If your plan covers air ambulance services, the No Surprises Act protects you even if the air ambulance company is not in-network. You pay what you would have paid in-network.
Important Exception
The Notice & Consent Exception
In certain non-emergency situations, you may be asked to waive your surprise billing protections. Here is what you need to know.
When notice & consent IS allowed
When you schedule certain non-emergency services (not ancillary services) at an in-network facility
When you need post-stabilization care after an emergency and your provider is out-of-network
When notice & consent is NOT allowed
Any emergency services before your condition is stabilized
Ancillary services: anesthesiology, pathology, radiology, neonatology, assistant surgeons, hospitalists, diagnostic services
When no in-network provider is available
Services provided due to unforeseen urgent medical needs
You never have to sign the notice and consent form
Signing is entirely your choice. You should only sign if you agree to give up surprise billing protections for the specific items named in the notice. If you do not sign and the provider still provides care, the No Surprises Act protections continue to apply. The form must be provided at least 72 hours before your scheduled services.
Taking Action
What to do if you receive a surprise bill
Understanding your rights is the first step. Here is what to do if you think the law is being violated.
Check your Explanation of Benefits (EOB)
Medical bills and Explanations of Benefits are not the same thing. Before receiving a bill from a provider, you should receive an EOB from your health plan telling you:
What services you received and when
How much your plan will pay
How much you owe
Check your EOB for mistakes and review it every time. If you receive a bill before your EOB, contact your health plan to confirm the provider submitted a claim.
Steps to take
- 1
Read your EOB carefully. Compare it to the bill you received.
- 2
If the bill exceeds what the EOB shows you owe, contact the No Surprises Help Desk at 1-800-985-3059.
- 3
If your plan denied coverage, file an internal appeal by calling your plan and requesting the appeals procedure.
- 4
Submit your internal appeal in writing — your plan must respond promptly.
Get Help
Resources & Contacts
Multiple agencies are ready to help you understand and enforce your rights under the No Surprises Act.
DOL / EBSA
U.S. Department of Labor Employee Benefits Security Administration
1-866-444-3272EBSA No Surprises Act pageNo Surprises Help Desk
Federal help desk for billing complaints and questions. Available Mon–Fri 8am–8pm ET, Sat–Sun 10am–6pm ET.
1-800-985-3059Your State’s Department of Insurance
Some states have additional balance billing protections beyond federal law. Look up your state’s Department of Insurance website for more information.
Find your state’s insurance departmentInformation on this page is sourced from the U.S. Department of Labor — “Avoid Surprise Healthcare Expenses”. For the most current information, visit dol.gov.
Questions about your billing?
We are happy to discuss your coverage and fees before your first appointment — no surprises here.