Author: Drew M. Widders

What is the No Surprises Act?

The No Surprises Act is a federal law that protects patients from unexpected medical bills, particularly in emergencies or situations where they receive care from out-of-network providers at in-network facilities. It was signed into law on December 27, 2020, and went into effect on January 1, 2022.

The law primarily aims to prevent balance billing, a practice where a healthcare provider charges a patient the difference between their full rate and what the patient’s insurance pays. This often leads to high, unexpected bills, especially when patients unknowingly receive care from out-of-network providers.

Why Was the No Surprises Act Created?

Many Americans faced surprise medical bills after emergency room visits or procedures at in-network hospitals where out-of-network doctors provided care. Before the law, patients could be responsible for thousands of dollars in unexpected charges. The No Surprises Act ensures that patients are not charged more than in-network rates for emergency services and certain non-emergency situations.

Key Protections Under the No Surprises Act

  1. Emergency Services: Patients receiving emergency care cannot be charged more than in-network rates, even if they are treated by out-of-network providers or at out-of-network facilities.
  2. Non-Emergency Services at In-Network Facilities: If a patient receives care at an in-network hospital but is unknowingly treated by an out-of-network provider (such as an anesthesiologist or radiologist), they cannot be balance billed.
  3. Air Ambulance Services: The law protects patients from surprise bills for emergency air ambulance services, ensuring they only pay in-network cost-sharing amounts.
  4. Advance Notice for Out-of-Network Care: In certain non-emergency cases, out-of-network providers can balance bill a patient only if they provide written notice and receive patient consent.
  5. Dispute Resolution Process: If patients or providers disagree with the amount insurance covers, they can use an independent dispute resolution process to settle the bill.

What About Ambulance Services?

While air ambulances are covered under the No Surprises Act, ground ambulance services are not currently included. However, the law did establish a committee to explore ways to extend protections to ground ambulance bills in the future.

California’s Additional Protections (AB 716)

California has gone further in protecting patients. Under AB 716, which took effect on January 1, 2024:

  • Ground ambulance providers cannot charge more than in-network rates.
  • Uninsured patients cannot be charged more than the Medicare or Medi-Cal rate (whichever is higher).
  • Debt collectors are restricted from pursuing legal action or reporting unpaid bills to credit agencies for at least 12 months after billing.

What Should Patients Do If They Receive a Surprise Bill?

  1. Check the Bill: Ensure the charges align with the No Surprises Act’s protections.
  2. Contact Your Insurance Provider: Verify what should be covered.
  3. File a Complaint: If you believe you were wrongly billed, you can report it to the Centers for Medicare & Medicaid Services (CMS) at 1-800-985-3059.
  4. Request an Explanation from the Provider: If a hospital or provider is still attempting to balance bill you, ask for a detailed explanation and mention the No Surprises Act.
  5. Use the Dispute Resolution Process: If necessary, work through the independent dispute resolution process to challenge the bill.

Conclusion

The No Surprises Act provides significant protections for patients by limiting surprise medical bills and ensuring fair cost-sharing for out-of-network services. While some challenges remain—such as addressing ground ambulance costs—this law represents a major step toward transparent and fair medical billing practices. If you receive a surprise bill, knowing your rights can help you avoid unnecessary expenses and fight unfair charges.

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