What is the No Surprises Act and how does it protect me?

Surprise medical bills — charges you never agreed to from a provider you did not choose — used to be one of the most common ways patients got overcharged. The No Surprises Act changed that.

What the law covers

The No Surprises Act took effect January 1, 2022. Its core protections:

• Emergency services must be billed at in-network rates, even at an out-of-network hospital. You cannot be balance-billed for the difference.
• Out-of-network providers at in-network facilities — for example, an out-of-network anesthesiologist or radiologist at your in-network hospital — generally cannot balance-bill you beyond your normal in-network cost-sharing.
• Air ambulance services are covered by the same balance-billing protections.

What "balance billing" means

Balance billing is when a provider bills you for the difference between their charge and what your insurer pays. For the protected situations above, that practice is now largely prohibited — you owe only your in-network deductible, copay, or coinsurance.

The Good Faith Estimate (for uninsured & self-pay)

If you are uninsured or paying cash, providers must give you a Good Faith Estimate of expected charges before scheduled care. If your final bill exceeds the estimate by $400 or more, you may be able to challenge it through the patient-provider dispute resolution process.

How to tell if your bill violates the law

Look for an out-of-network charge tied to an emergency, or a separate bill from a provider you did not choose at an in-network facility. If you see balance billing in those situations, the charge may be improper. Keep your insurer’s explanation of benefits and the bill side by side.

What to do about a suspected violation

1. Contact the provider and your insurer and state that the charge appears to violate the No Surprises Act.
2. Ask for a corrected bill reflecting in-network cost-sharing.
3. If unresolved, you can file a complaint with the federal No Surprises Help Desk.

Upfronte checks bills for No Surprises Act violations as part of every audit and cites the relevant protections when negotiating on your behalf. Upload your bill to have it checked.

This guide is general information, not legal advice. Protections have exceptions, and some non-emergency situations allow providers to obtain advance consent to waive them.