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The No Surprises Act: What It Covers and What It Doesn't

The law that was supposed to end surprise medical bills. What it actually protects you from — and where the gaps are that most people don't know about.

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The Law — What Changed January 1, 2022

The No Surprises Act took effect January 1, 2022, and it was a genuine patient protection. Before it passed, patients regularly received large bills from out-of-network providers at in-network facilities — especially from emergency room physicians, anesthesiologists, radiologists, and other specialists they never chose and often never met. The law eliminated most of those bills. But it does not protect you from all surprise bills.

What It Covers vs. What It Doesn't
Covered by the Law
Emergency services at any ER — you pay in-network rates regardless of the hospital or physician network status
Out-of-network providers at in-network facilities you did not choose — anesthesiologists, radiologists, pathologists
Air ambulance services — cost-sharing capped at in-network amounts
Good Faith Estimates for uninsured or self-pay patients
NOT Covered by the Law
Scheduled out-of-network care you voluntarily consent to in writing
Out-of-network facilities — the law protects at in-network facilities, not at out-of-network facilities
Ground ambulances — specifically excluded from the law
High deductibles, rising copays, or general cost increases within your plan
The No Surprises Act is narrower than most people believe. Ground ambulance surprise billing remains a significant problem — some states have addressed it separately, but there is no federal protection.
If You Receive a Bill That Violates the Law
Contact your insurer and report that the bill appears to violate the No Surprises Act. Ask them to verify the claim was processed at the correct in-network rate.
Contact the provider's billing department and state specifically that you believe the bill violates the No Surprises Act. Ask them to reprocess the claim.
File a complaint with the federal No Surprises Help Desk at 1-800-985-3059 or through the CMS website. Providers who violate the law face civil monetary penalties.
Contact your state insurance commissioner — many states have additional protections that go beyond the federal law.
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