You go to the hospital thinking your insurance will cover the visit—only to get a massive bill from an out-of-network doctor you never even met. Sound familiar? You’re not alone. Surprise medical bills have long been a frustrating reality for insured patients. But now, thanks to the No Surprises Act, many of those unexpected charges are a thing of the past. This new law offers critical protections against surprise billing in emergency and certain non-emergency situations. Here’s what the No Surprises Act means for you—and how to make sure you’re fully protected.
What Is the No Surprises Act?
The No Surprises Act is a federal law that went into effect on January 1, 2022, designed to protect patients from unexpected medical bills for out-of-network care in specific situations. It applies to:
People with employer-sponsored insurance, Marketplace plans, or individual health insurance
Emergency care, non-emergency services at in-network facilities, and air ambulance services
Before this law, it was common for insured patients to receive large bills when they unknowingly received treatment from an out-of-network provider—especially in emergency situations or during hospital stays.
What Does the Law Cover?
The No Surprises Act applies in three key situations:
Emergency Services
If you go to the ER—whether the hospital is in-network or not—you’re protected.
You can’t be charged more than in-network rates for emergency care
This includes ER doctors, testing, and related hospital services
It also applies to air ambulance transport (but not ground ambulances, which are often regulated by states)
Non-Emergency Services at In-Network Hospitals
Even in an in-network facility, out-of-network specialists (like anesthesiologists or radiologists) might be involved in your care. The law now prevents these surprise bills.
You can’t be charged more than in-network rates for these services
Applies to things like surgeries, lab tests, or imaging when performed at an in-network hospital
Air Ambulance Services
If you require air ambulance transport—one of the most expensive and surprise-prone services—the law caps your out-of-pocket costs based on in-network rules.
What’s Not Covered?
While the No Surprises Act covers many scenarios, there are a few important exceptions:
Ground ambulance services: These are not included in the federal law (some states have separate protections)
Out-of-network care at non-hospital settings: If you voluntarily schedule care with an out-of-network provider and sign a consent form, you could still be billed
Health sharing plans and non-ACA compliant insurance: These may not offer the same protections
Tip: If you’re scheduling non-emergency care, always verify that your provider and facility are in-network—and ask about anyone else involved (like labs or assistants).
How It Helps Patients
Here’s how the law protects you as a patient:
Caps costs at in-network levels for covered situations
Bans balance billing (when providers bill you for the difference between what your plan pays and what they charge)
Increases transparency by requiring upfront estimates for some services
Creates a dispute resolution system between providers and insurers—keeping you out of the middle
What If You Still Get a Surprise Bill?
If you receive a bill that doesn’t look right:
Review your Explanation of Benefits (EOB) from your insurer to see what was paid
Contact your insurance company to ask if the service was supposed to be protected
Call the provider and ask why you were billed more than the in-network rate
File a complaint or dispute through the federal No Surprises Help Desk at 1-800-985-3059 or at CMS.gov/nosurprises
You have at least 120 days from the date on the bill to file a dispute.
Your Right to Good Faith Estimates
Another important part of the law is the Right to a Good Faith Estimate for uninsured or self-pay patients.
Providers must give you a written estimate of expected charges before your scheduled service
If your final bill is $400 or more above the estimate, you can dispute it through the patient-provider dispute resolution process
This helps reduce financial surprises even for people without insurance.
How to Protect Yourself
To stay fully protected under the No Surprises Act:
Always ask if providers are in-network before receiving non-emergency care
Read any forms carefully before signing—some may waive your protections
Keep copies of bills, EOBs, and communications
Use the federal hotline or website if you need help with a disputed bill
Knowledge is your best defense. The more you understand your rights, the easier it is to challenge a bill that doesn’t belong on your tab.
Final Thoughts
The No Surprises Act is a major win for patients. It takes the pressure off you in moments when you’re already focused on your health—and ensures you’re not left footing the bill for something you couldn’t control. But like any new law, it only works if people know it exists and use it. So stay informed, double-check your bills, and don’t hesitate to speak up. Your rights are protected, and now, your wallet is too.
