The No Surprises Act is a federal law that took effect January 1, 2022, to protect people from most instances of “surprise” medical bills. The legislation was included in the Consolidated Appropriations Act 2021, signed into law in December 2020.
Here is an overview by the Centers for Medicare and Medicaid Services (CMS) on the No Surprises Act.
What is a surprise medical bill?
A surprise medical bill is an unexpected bill. It is often for services received from a healthcare provider or facility that you did not know was out-of-network until you were billed.
Your health insurance may not cover the entire out-of-network cost. This leaves you owing the difference between the billed cost and the amount your health insurance paid. This is known as “balance billing.”
The bill could be for a service like anesthesiology or laboratory tests.
How does the No Surprises Act protect patients?
The No Surprises Act (NSA) protects you from surprise billing if you have a group health plan or group or individual health insurance coverage. The law bans:
- Surprise bills for emergency services from an out-of-network provider or facility and without prior authorization;
- Out-of-network cost-sharing, like out-of-network coinsurance or copayments, for all emergency and some non-emergency services; and
- Out-of-network charges and balance bills for supplemental care, like radiology or anesthesiology, by out-of-network providers that work at an in-network facility.
If you are uninsured or if you pay for care without using health insurance, then you should receive a “good faith” estimate from your provider. Find out how much your care will cost before you get care.
Healthcare programs such as Medicare, Medicaid, Indian Health Services and health plans for military personnel and veterans may already provide protection against surprise medical billing.
If you are insured and your health plan denies all or part of a claim for service, you can appeal that decision. File a complaint if you receive a surprise bill for medical services provided on or after January 1, 2022 and already paid more than your in-network cost share (copayment, coinsurance or deductible). CMS has more information on resolving billing disputes.
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