No Surprises Act

From the No Surprises Act Toolkit for Consumer Advocates created by CMS

The No Surprises Act was signed into law on December 27, 2020.  This law gives consumers federal protections from surprise medical bills by prohibiting balance billing and limiting consumer cost sharing in certain circumstances where surprise billing has been common.

In general, the No Surprises Act protects consumers covered under group health plans and group and individual health insurance coverage.  This includes consumers with a plan or coverage obtained through an employer, the Federal Employees Health Benefits Program, the Health Insurance Marketplace, or an individual plan purchased directly from an insurance company.  The new surprise billing protections apply when these consumers receive: 

• Most emergency services from out-of-network providers or out-of-network emergency facilities;
• Non-emergency services from out-of-network providers with respect to a patient's visit to certain types of in-network health care facilities;
• Air ambulance services from out-of-network air ambulance service providers.

If consumers are uninsured or decide not to use their health insurance for a service, the new law enables them to get a good faith estimate of the expected cost of their care up front, before receiving the service.  If consumers receive a bill significantly higher than the estimate, they may be able to dispute the charges through a new federal arbitration process.  

The No Surprises Act also includes other new protections related to continuity of care, provider directories, health plan insurance cards, and more.  Most No Surprises Act provisions went into effect on January 1, 2022, although some have not yet been implemented.  See No Surprises Act Protections: Status of Implementation in this document.

If you need help, a No Surprises Help Desk is available for consumers if you receive a surprise bill.  Contact the No Surprises Help Desk at 1-800-985-3059 or you can submit a complaint online at https://www.cms.gov/medial-bill-rights/help/submit-a-complaint

State Consumer Assistance Programs (CAPs) may also help with surprise billing questions.  To see if your state has a CAP, please visit this state listing.