No Surprises Act: what it covers, what it doesn't, and how to use it

Since 1 January 2022, the federal No Surprises Act protects patients from many "surprise" out-of-network bills.

What it covers

1. 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.
2. 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.
3. 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

1. Compare your EOB with the bill - look for "out-of-network" on a service you didn't choose.
2. 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.
3. Tell your insurer too.
4. 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.

Generate your No Surprises Act letter.