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Effective January 1, 2022

No Surprises Act: Your Rights Against Surprise Medical Bills

A complete guide to understanding and using your federal protections against unexpected healthcare charges.

Your Rights Under This Law

  • Emergency room protection: You cannot be billed out-of-network rates for emergency care
  • In-network facility protection: You cannot receive surprise bills from out-of-network doctors at in-network facilities
  • Price transparency: You have the right to a good faith estimate for scheduled services
  • Dispute resolution: You can challenge bills through a federal independent dispute process

What Is the No Surprises Act?

The No Surprises Act is a federal law that took effect on January 1, 2022, designed to protect patients from unexpected medical bills. Before this law, millions of Americans received "surprise bills" - charges that were significantly higher than expected because a provider was out of their insurance network, even when the patient had no way of knowing this in advance.

These surprise bills could reach tens of thousands of dollars and often came from situations completely outside the patient's control: an out-of-network anesthesiologist at an in-network hospital, an emergency room visit where you had no choice of provider, or a specialist consultation where you weren't informed the doctor was out-of-network.

The No Surprises Act addresses these problems by establishing clear rules about when patients can and cannot be billed out-of-network rates, and by giving patients the right to know their expected costs in advance.

When Are You Protected from Surprise Bills?

The No Surprises Act provides protection in three main scenarios:

1. Emergency Services

You are protected from surprise bills when you receive emergency care, regardless of whether the hospital or provider is in your insurance network.

What this means:

  • • Emergency room visits cannot result in out-of-network charges
  • • Emergency transportation (ambulance) is covered
  • • Post-stabilization care is covered unless you consent otherwise
  • • Your copay/coinsurance is based on in-network rates

2. Non-Emergency Care at In-Network Facilities

You are protected from surprise bills when you receive non-emergency care at an in-network hospital or ambulatory surgical center, even if some providers are out-of-network.

Common examples:

  • • An out-of-network anesthesiologist assists with your surgery
  • • An out-of-network pathologist analyzes your lab samples
  • • An out-of-network radiologist reads your imaging results
  • • An out-of-network assistant surgeon helps during your procedure

3. Air Ambulance Services

You are protected from surprise bills for air ambulance services, which previously were a major source of unexpected charges (often $20,000-$50,000 or more).

Important note:

Ground ambulances are NOT covered by the No Surprises Act and remain a common source of surprise bills. Contact your state insurance department for ground ambulance protections in your state.

Your Right to a Good Faith Estimate

One of the most important parts of the No Surprises Act is your right to receive a "good faith estimate" of your expected costs before receiving scheduled healthcare services. This applies whether you have insurance or are paying out-of-pocket.

What Is a Good Faith Estimate?

A good faith estimate is a written document that lists:

  • • Expected charges for the primary service or item
  • • Expected charges for any additional items or services reasonably expected
  • • Service codes and descriptions in plain language
  • • The date the estimate was created
  • • A disclaimer that the estimate is not a contract

When You're Entitled to an Estimate

Uninsured or Self-Pay Patients

  • • Automatically provided
  • • Within 1 business day if scheduled 3-9 days out
  • • Within 3 business days if scheduled 10+ days out

Insured Patients

  • • Must request in writing
  • • Provider must respond within 3 business days
  • • Estimate should reflect your insurance coverage

What to Do If Your Bill Is More Than Expected

If you receive a bill that is substantially more than your good faith estimate ($400 or more for a single provider/facility), you have the right to dispute it through a federal patient-provider dispute resolution process.

Steps to Dispute a Surprise Bill

  1. 1.
    Start the dispute within 120 days of receiving the bill
  2. 2.
    Contact the provider and try to resolve it directly first
  3. 3.
    Initiate the federal dispute process if direct negotiation fails
  4. 4.
    Pay a $25 administrative fee to start the dispute (refundable if you win)
  5. 5.
    Wait for decision - the resolution entity will decide if you're owed a refund

Resources and Contact Information

Federal Help Line (No Surprises Act)

Phone: 1-800-985-3059

TTY: 1-866-626-3972

Centers for Medicare & Medicaid Services (CMS)

Website: cms.gov/nosurprises

Patient-Provider Dispute Resolution

Website: cms.gov/nosurprises/help-resolve-payment-disputes

Exceptions and Limitations

While the No Surprises Act provides strong protections, there are some important exceptions to know about:

When You CAN Still Get Surprise Bills:

  • • If you specifically consent to waive your protections (must be voluntary and informed)
  • • Ground ambulance services (not covered by federal law - check state laws)
  • • If you knowingly choose an out-of-network provider for non-emergency care
  • • Services not considered "emergency" if you're stable and can be transferred

Important Considerations:

  • • Post-stabilization care may require consent to continue at out-of-network facility
  • • You should never feel pressured to waive your protections
  • • Always ask for in-network alternatives before consenting to out-of-network care
  • • Keep all consent forms and good faith estimates for your records

How to Protect Yourself

Even with the No Surprises Act in place, it's important to be proactive about protecting yourself from unexpected medical bills:

Before Scheduling Care

Request a good faith estimate and verify that all providers involved are in-network

At the Facility

Ask about network status of all providers who will be involved in your care (surgeons, anesthesiologists, radiologists, etc.)

Review Consent Forms

Never sign forms waiving your No Surprises Act protections unless absolutely necessary and you understand the implications

After Receiving Bills

Compare bills to your good faith estimate and question any charges that seem significantly higher

Know Your Costs Before You Go

Use Aphenos to compare hospital prices and get a realistic estimate of your out-of-pocket costs before scheduling care.

Search Hospital Prices Now

100% free • No login required • Real hospital pricing data

Related Resources

→ Hospital Price Transparency Rule→ How to Compare Hospital Prices