The No Surprises Act (2022): Your Complete Rights Guide
Quick Answer
The No Surprises Act protects you from unexpected out-of-network medical bills when you receive emergency care or treatment at in-network facilities from out-of-network providers you didn't choose. If you receive a bill that violates the NSA, you can file a complaint with the Centers for Medicare & Medicaid Services (CMS) and should not be required to pay more than your in-network cost-sharing amount.
The No Surprises Act (NSA), which took effect on January 1, 2022, represents one of the most significant patient financial protections in recent healthcare legislation. This federal law addresses the long-standing problem of surprise medical bills—those unexpected charges that occur when patients unknowingly receive care from out-of-network providers. Understanding your rights under this law can save you thousands of dollars and significant stress when navigating medical billing disputes.
What the No Surprises Act Protects Against
The NSA provides protection in two primary scenarios. First, it covers emergency services regardless of where you receive them. If you go to an emergency room—whether at an in-network or out-of-network facility—you cannot be balance billed for the emergency care you receive. This protection extends to air ambulance services provided by out-of-network providers, though ground ambulance services are notably excluded from the law's protections.
Second, the NSA protects you when you receive non-emergency care at in-network facilities but are treated by out-of-network providers you did not choose. This commonly occurs with anesthesiologists, radiologists, pathologists, and assistant surgeons who may not be in your insurance network even though the hospital or surgical center is. Under the NSA, these providers cannot bill you more than your in-network cost-sharing amount.
The law requires providers and facilities to give you a good faith estimate of expected charges before scheduled services if you are uninsured or choose not to use insurance. If your final bill exceeds this estimate by $400 or more, you have the right to dispute the charges through a patient-provider dispute resolution process.
Important Limitations of the NSA
The No Surprises Act does not protect you in all situations. If you voluntarily choose to receive care from an out-of-network provider and sign a consent form acknowledging the potential for higher costs, the NSA protections generally do not apply. Providers must give you this notice at least 72 hours before scheduled services (or on the day of service for appointments made within 72 hours).
Additionally, the NSA does not cover ground ambulance services, which remain a significant source of surprise bills. The law also does not apply to short-term health insurance plans, health care sharing ministries, or certain grandfathered health plans. State laws may provide additional protections in some of these areas, so checking your state's regulations is worthwhile.
The Independent Dispute Resolution Process
When billing disputes arise between providers and insurers under the NSA, they are resolved through an Independent Dispute Resolution (IDR) process. This federal arbitration system allows either party to initiate a dispute after an initial 30-day negotiation period fails to produce agreement. An independent arbitrator then reviews both parties' offers and selects one—there is no splitting the difference.
As a patient, the IDR process happens behind the scenes. Your responsibility is limited to your in-network cost-sharing amount (deductible, copay, or coinsurance), and the dispute over the remaining balance is strictly between your insurer and the provider. You should not receive collection notices or threats related to amounts under IDR dispute.
Filing Complaints and Protecting Your Rights
If you believe a provider or facility has violated the No Surprises Act, you have the right to file a complaint with the Centers for Medicare & Medicaid Services (CMS). The agency has established a dedicated complaint process for NSA violations, accessible through the CMS No Surprises Help Desk.
When filing a complaint, gather all relevant documentation including the original bill, your Explanation of Benefits (EOB), any good faith estimates you received, and records of communication with the provider. CMS investigates complaints and can impose civil monetary penalties on providers who violate the law—penalties that can reach over $10,000 per violation.
If you receive a surprise bill that you believe violates the NSA, do not simply pay it. Contact your insurance company to verify whether the charges should be covered under NSA protections, then communicate in writing with the provider explaining why you believe the bill violates federal law. Many providers will correct billing errors once they understand the NSA implications.
Frequently Asked Questions
Does the No Surprises Act apply to my employer-sponsored health insurance?
Yes, the NSA applies to most employer-sponsored group health plans, individual health insurance plans purchased through the marketplace or directly from insurers, and FEHB plans for federal employees. However, it does not apply to grandfathered plans, short-term insurance, or health care sharing ministries.
Can a provider ask me to waive my No Surprises Act protections?
In limited circumstances, out-of-network providers can ask you to waive NSA protections for non-emergency services, but strict requirements apply. You must receive notice at least 72 hours in advance, the waiver must list alternative in-network providers, and certain providers like anesthesiologists and emergency physicians cannot request waivers. You are never required to sign a waiver.
What should I do if I receive a bill for emergency care from an out-of-network provider?
Contact your insurance company immediately to report the bill as a potential NSA violation. Under the law, you should only owe your in-network cost-sharing amount for emergency services. Send a written dispute to the provider citing the No Surprises Act, and if the issue is not resolved, file a complaint with CMS.
Are there any costs I might still owe under the No Surprises Act?
Yes, you remain responsible for your in-network deductible, copayments, and coinsurance even when NSA protections apply. The law ensures you will not pay more than you would have if the provider had been in-network, but it does not eliminate your standard cost-sharing obligations under your health plan.
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