The No Surprises Act — What It Covers and What It Doesn't

What Is the No Surprises Act?

The No Surprises Act is a federal law that took effect January 1, 2022. It protects patients from unexpected medical bills — often called surprise bills — when they receive care from out-of-network providers in specific situations.

Before this law, patients could receive enormous bills from out-of-network providers they never chose — anesthesiologists, radiologists, assistant surgeons, and emergency physicians who happened to be at an in-network facility.

What the No Surprises Act Covers

Emergency care

When you receive emergency services at any hospital emergency room — in-network or out-of-network — you cannot be billed more than your in-network cost-sharing amount. The provider cannot balance bill you for the difference between their charge and what the insurer pays.

Out-of-network providers at in-network facilities

When you receive non-emergency care at an in-network facility and an out-of-network provider participates in your care without your knowledge or consent — such as an anesthesiologist or assistant surgeon — those providers cannot balance bill you.

Air ambulance services

Out-of-network air ambulance services from FAA-certified providers are subject to No Surprises Act protections.

What the No Surprises Act Does Not Cover

• Ground  ambulance services — these are explicitly excluded and remain a significant gap
• Situations  where you knowingly and voluntarily chose an out-of-network provider after receiving proper notice and providing written consent
• Out-of-network services at out-of-network facilities where you chose to receive care
• Care received outside the United States

What to Do If You Receive a Surprise Bill

Step 1 — Determine if the No Surprises Act applies

Review the circumstances of your care — was it an emergency? Were you at an in-network facility? Did you receive advance notice about out-of-network providers?

Step 2 — Contact your insurer File a claim or dispute through your insurance company.

They are required to apply No Surprises Act protections to qualifying bills.

Step 3 — File a complaint

If a provider bills you inviolation of the No Surprises Act, file a complaint with the No Surprises HelpDesk at 1-800-985-3059 or online at cms.gov.

Step 4 — Request an independent dispute resolution if needed

For qualifying items and services, the independent dispute resolution process is available to resolve payment disputes between insurers and providers.

How ClaimCompass Helps

ClaimCompass analyzes your surprise billing situation and generates a formal dispute letter asserting your rights under the No Surprises Act.

Upload your bill or denial at myclaimcompass.ai for a free analysis.

Frequently Asked Questions

What is balance billing?

Balance billing is when a provider bills you for the difference between their charge and what your insurer paid. The No Surprises Act prohibits balance billing in qualifying situations.

Can I waive my No Surprises Act rights?

Only in limitednon-emergency circumstances and only after receiving specific written notice and providing written consent. For emergency care, these protections cannot be waived.

Does the No Surprises Act apply to ground ambulances?

No. Ground ambulances are explicitly excluded from No Surprises Act protections. This is one of the most significant remaining gaps in surprise billing protection.

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