Surprise Medical Bills: What the No Surprises Act Protects You From
Learning goal: Know which out-of-network bills the No Surprises Act protects you from, what a good faith estimate is, and what to do if you get a bill you shouldn't.
Short answer
The No Surprises Act, in effect since January 1, 2022, protects most insured people from surprise out-of-network bills for emergency care, and for certain care at in-network hospitals and surgery centers, like an out-of-network anesthesiologist. Uninsured people can get a good faith estimate, and may dispute a bill at least $400 above it.
Read to the end to complete this lesson.
On this page
The Fuller Picture
Before the law, a patient at an in-network hospital could get a large bill from an out-of-network doctor they didn't choose. Now, in protected situations, you generally pay only your in-network cost sharing. If you think a provider or insurer isn't following the rules, you can submit a complaint through the federal No Surprises help desk.
Key Takeaways
- CMS: "The No Surprises Act protects you from unexpected out-of-network medical bills for emergency room visits."
- It also covers certain non-emergency care at in-network hospitals, outpatient departments and ambulatory surgical centers.
- It applies to most types of health insurance.
- Without insurance, you can get a good faith estimate, and may dispute a bill at least $400 more than it.
- You can submit a complaint if providers or insurers aren't following the rules.
Real-World Example
Ben
Ben has knee surgery at an in-network surgery center. Weeks later he gets a $2,200 bill from the anesthesiologist, who is out of network. Because the care was at an in-network facility, the No Surprises Act generally limits him to his in-network cost sharing. He calls his insurer, cites the law, and submits a complaint when the bill isn't corrected.
Common Mistakes
- Paying a surprise out-of-network bill without checking your protections.
- Not asking for a good faith estimate when uninsured.
- Assuming the law covers any out-of-network visit you choose.
- Not keeping the bill and explanation of benefits.
Interactive Exercise
If You Get a Surprise Bill
Work through these before paying.
Tick each step as you do it. Your checklist is saved in this browser.
Knowledge Check
Question: Which situation is the No Surprises Act designed to protect you in?
Recommended Insurpedia Tools
- Insurance Preparedness Checklist: Twelve insurance questions worth having an answer to, with a place to learn more about each one you have not looked at yet. No score.
Related Insurance Terms
Related Scenarios
Questions to explore next
Questions readers often ask next about this topic:
- Is my surprise bill protected by the No Surprises Act?
- How do I ask for a good faith estimate?
- How do I submit a No Surprises complaint?
- What should my in-network cost sharing be?
See every lesson in the Health Insurance course.
Explore the course →Sources
The factual claims on this page were checked against these sources. Rules and figures change, so check the source itself if you need to confirm the current version.
- cms.govThe No Surprises Act protects people from unexpected medical bills · U.S. Centers for Medicare & Medicaid Services (CMS)
Educational information, not advice: This lesson is for general education only, not legal, financial, or insurance advice. Actual coverage, discounts, and requirements depend on your policy’s wording, your insurer, and the laws of your state. Confirm specifics with your own insurer or a licensed agent before making a decision. Insurpedia does not sell insurance and does not recommend specific insurers. The No Surprises Act protections are from CMS's consumer page. Some plans and situations differ. Educational information, not legal advice.