Your rights under the No Surprises Act

The No Surprises Act protects consumers from unexpected medical bills from out-of-network providers in emergency situations and for certain non-emergency services. You have the right to a "good faith estimate" for scheduled services.

Step-by-step playbook

Identify a surprise bill — Determine if your bill is for emergency services, out-of-network care at an in-network facility, or significantly exceeds a Good Faith Estimate [S1, S6].
Gather documentation — Collect your Explanation of Benefits (EOB), Good Faith Estimate (if applicable), and any correspondence with providers or insurers [S7, S6].
Contact your health plan — Reach out to your insurance company and explain that you believe the bill violates the No Surprises Act. Request that they reprocess the claim based on in-network rates [S7].
Contact the provider/facility — Inform the billing department that you are protected by the No Surprises Act and ask them to adjust the bill to in-network rates or the Good Faith Estimate [S7].
File a formal complaint — If necessary, file a complaint with the No Surprises Help Desk or your state's Department of Insurance [S8]. For Good Faith Estimate disputes, initiate the process within 120 days of the bill [S6].

Your rights

Protection from Balance Billing — You cannot be balance billed for out-of-network emergency services or for certain non-emergency services from out-of-network providers at an in-network facility [S2, S3].
In-Network Cost Sharing — For protected services, you are only responsible for your in-network copayment, coinsurance, or deductible amount [S2].
Good Faith Estimate — You have the right to receive an advance "good faith estimate" of charges for scheduled non-emergency services [S5].
Dispute Process for Estimates — If your final bill is $400 or more above your Good Faith Estimate, you have the right to dispute the bill through a patient-provider dispute resolution process [S6].
Clear Communication — Providers and facilities must give you a simple, easy-to-understand notice explaining your No Surprises Act protections [S1].

Who to contact

No Surprises Help Desk — https://www.cms.gov/nosurprises/consumers/complaints-and-assistance/contact-us
CMS No Surprises Act Complaints — https://www.cms.gov/nosurprises/consumers/complaints-and-assistance
Federal Register (Good Faith Estimate) — https://www.federalregister.gov/documents/2021/10/07/2021-21448/requirements-related-to-surprise-billing-part-ii
National Association of Insurance Commissioners (NAIC) — https://www.naic.org/index.htm

Understanding Your Rights Under the No Surprises Act

The No Surprises Act (NSA) took effect on January 1, 2022, protecting consumers from certain unexpected medical bills [S1]. This federal law primarily addresses "surprise billing," which occurs when insured individuals receive an unexpected bill from an out-of-network provider or facility [S1]. This often happens in emergencies or when patients unknowingly receive care from an out-of-network provider at an in-network facility [S1].

Your Rights

Under the NSA, you are protected from surprise medical bills in several key situations:

Emergency Services: Regardless of where you receive emergency care (hospital or freestanding emergency department) or the provider's network status, you cannot be balance billed for out-of-network emergency services [S2]. You should only be charged your in-network cost-sharing amount (copay, coinsurance, deductible) for these services [S2].
Non-Emergency Services at In-Network Facilities: If you receive non-emergency services from an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise bills for specific services [S3]. This includes services like anesthesiology, pathology, radiology, laboratory services, and certain assistant surgeon services [S3]. Your cost-sharing for these services should be based on your in-network rate [S3].
Air Ambulance Services: You are protected from surprise billing for out-of-network air ambulance services [S4]. This protection does not apply to ground ambulance services currently [S4].
Good Faith Estimates: For scheduled non-emergency services, providers and facilities must provide you with a "good faith estimate" of expected charges within specific timeframes [S5]. If you schedule a service at least 3 business days in advance, you should receive the estimate within 1 business day [S5]. If you schedule at least 10 business days in advance, you should receive it within 3 business days [S5]. You can also request an estimate at any time [S5]. If your actual bill is at least $400 more than the good faith estimate, you may be able to dispute it [S6].

How to Dispute

If you believe you've received a bill that violates the No Surprises Act:

Contact your health plan or provider: The first step is to contact your health plan and the provider or facility that billed you [S7]. Explain that you believe the bill violates the No Surprises Act and request that it be reprocessed [S7].
Review your Explanation of Benefits (EOB): Your EOB from your insurer should clearly indicate how the claim was processed and if any amount was deemed a surprise bill [S7].
File a complaint: If your health plan or provider does not resolve the issue, you can file a complaint with the federal government or your state's Department of Insurance [S7, S8]. The Centers for Medicare & Medicaid Services (CMS) handles complaints for most states, while some states have their own programs [S8].
Dispute Good Faith Estimates: If your final bill for a scheduled service is $400 or more above your Good Faith Estimate, you have the right to initiate a patient-provider dispute resolution process [S6]. You must initiate this process within 120 calendar days of the date on the original bill [S6].

Common Traps

Waiving Your Rights: For certain non-emergency services, an out-of-network provider may ask you to sign a form agreeing to be billed out-of-network. This is called a "notice and consent" form [S3]. If you sign this form, you may be responsible for the full out-of-network costs. However, they cannot ask you to sign this form for emergency services or for services like anesthesiology, radiology, and pathology, even in non-emergencies at in-network facilities [S3]. Always read carefully before signing.
Ground Ambulance Services: The No Surprises Act does not currently cover ground ambulance services, which remain a common source of surprise bills [S4].
Understanding Your Plan: While the NSA offers significant protections, understanding your health plan's network and cost-sharing responsibilities is still crucial to avoid unexpected costs [S9].

When to Escalate

If your appeals with your provider and health plan are unsuccessful, or if you encounter resistance to providing a `Good Faith Estimate`:

Contact the No Surprises Help Desk: The federal government operates a help desk specifically for questions and complaints related to the No Surprises Act [S8].
State Regulators: For some insured plans, your state's Department of Insurance or health consumer protection agency may be the primary regulator [S8]. Always check who regulates your specific plan, as this can vary.
Federal Government: For most plans, you can file a complaint directly with the Centers for Medicare & Medicaid Services (CMS) [S8].

Sources

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