No Surprises Act

The No Surprises Act is federal legislation that took effect January 2022 to protect patients from balance billing in emergency situations and at in-network facilities. If you go to an in-network hospital for surgery and the anesthesiologist happens to be out-of-network, the NSA blocks that anesthesiologist from balance-billing you. You pay only what you would have owed if the provider were in-network.

The law covers emergency care at any facility, non-emergency care by out-of-network providers at in-network facilities (anesthesia, radiology, pathology, hospitalist services), and air ambulance services. Ground ambulance was excluded and remains a common source of surprise bills. The NSA also created an Independent Dispute Resolution (IDR) process where providers and plans arbitrate the payment amount for covered services — a process that has generated significant litigation and administrative backlog. Patients have a right to a Good Faith Estimate for self-pay services and can dispute bills that exceed the estimate by more than $400. The Consumer Financial Protection Bureau has also moved to bar medical debt from credit reports, which complements the NSA's protections.

The takeaway: if you receive a balance bill after emergency care or in-network facility care, do not pay it. File a complaint at cms.gov/nosurprises and dispute the bill in writing citing the No Surprises Act. Most providers back down once the law is invoked correctly.