No Surprise Billing Act: What It Means for Your Hospital Bills

The No Surprises Act, which took effect January 1, 2022, provides important protections against unexpected medical bills. Understanding your rights under this law can save you thousands of dollars and significant stress.

What Is Surprise Billing?

Surprise billing (also called "balance billing") occurs when a patient receives an unexpected bill from an out-of-network provider. Common scenarios include:

• Receiving care at an in-network hospital but being treated by an out-of-network physician (such as an anesthesiologist, radiologist, or assistant surgeon)
• Being transported by an out-of-network air ambulance
• Receiving emergency care at an out-of-network facility

Key Protections Under the No Surprises Act

Emergency Services

• Out-of-network providers cannot charge you more than in-network cost-sharing for emergency services
• This applies at both in-network and out-of-network emergency departments
• Protection extends to post-stabilization care until you can safely be transferred

Non-Emergency Services at In-Network Facilities

• Out-of-network providers at in-network facilities cannot send you surprise bills
• You pay only in-network cost-sharing amounts
• Applies to services like anesthesiology, radiology, pathology, and other services you may not choose yourself

Air Ambulance Services

• Out-of-network air ambulance providers cannot balance-bill you beyond in-network rates
• Ground ambulance is not covered by this law (subject to separate regulation)

Good Faith Estimates

• If you are uninsured or plan to self-pay, you have the right to a good faith estimate of expected charges before non-emergency services
• If the final bill exceeds the estimate by $400 or more, you can dispute it through the patient-provider dispute resolution process

When the Law Does NOT Apply

• If you knowingly consent to out-of-network care by signing a written consent and waiver (except for emergency services and certain ancillary providers)
• Ground ambulance services
• Services at out-of-network facilities where you chose to go (non-emergency)

What to Do If You Receive a Surprise Bill

• Review the bill to determine if it violates the No Surprises Act
• Contact your insurance company about the bill
• Contact the provider's billing office and reference the No Surprises Act
• File a complaint with CMS at 1-800-985-3059 if you believe the law has been violated
• Use the dispute resolution process if needed

Data sourced from CMS. Visit Medicare Care Compare or call 1-800-MEDICARE.

Disclaimer: This article is for informational purposes only and does not constitute legal or financial advice.