Understanding the No Surprises Act

Effective January 1, 2022, the No Surprises Act is a federal law designed to protect consumers from unexpected medical bills, particularly in situations where they have little or no control over who provides their care.

What Does the Act Do?

The No Surprises Act prohibits certain out-of-network charges and balance billing in specific scenarios: ([PDF] The No Surprises Act at a Glance Protecting Consumers ... - CMS)

• Emergency Services: You can't be charged more than the in-network cost-sharing amount for emergency services, even if they're provided by an out-of-network facility or provider. ([PDF] High level overview of No Surprises Act provider requirements - CMS)

• Non-Emergency Services at In-Network Facilities: When you receive non-emergency care at an in-network hospital or ambulatory surgical center, you are protected from higher out-of-network charges if you're unknowingly treated by an out-of-network provider. (Medical bill rights - CMS)

• Air Ambulance Services: Out-of-network air ambulance providers cannot bill you more than the in-network cost-sharing amount. ([PDF] High level overview of No Surprises Act provider requirements - CMS)

Who Is Covered?

These protections apply to individuals with: (Medical bill rights - CMS)

• Employer-sponsored health plans ([PDF] The No Surprises Act at a Glance Protecting Consumers ... - CMS)

• Individual or family health insurance plans purchased through the Health Insurance Marketplace or directly from insurers

• Federal Employees Health Benefits (FEHB) Program (Independent dispute resolution reports - CMS)

Note: These protections do not apply to individuals with coverage through programs like Medicare, Medicaid, TRICARE, or the Veterans Health Administration, as these programs have their own billing protections. ([PDF] The No Surprises Act at a Glance Protecting Consumers ... - CMS)

Additional Protections

• Good Faith Estimates: If you're uninsured or choosing to pay out-of-pocket, providers must give you a good faith estimate of expected charges before you receive care. (Medical bill rights - CMS)

• Dispute Resolution: If you receive a bill that's significantly higher than the good faith estimate, you have the right to dispute the charges through a new federal process. (No Surprises: Understand your rights against surprise medical bills)

Learn More

For more detailed information about your rights under the No Surprises Act, visit the official CMS page: No Surprises Act – CMS.gov