Navigating the No Surprises Act: What Every American Needs to Know
- Paisley Zenith, PMI, MS
- Jul 10
- 6 min read
This article provides a clear, practical guide to the No Surprises Act, explaining your rights, what services are covered, and what steps to take to protect yourself from unexpected medical bills.
 | As new medical situations and legal details emerge, understanding this law provides people with clarity during stressful times. It’s not just about legal rights—it’s about helping individuals feel more secure and confident when dealing with medical procedures, financial issues, or unexpected care situations. |
Takeaways
Protects you from surprise bills for most emergency care.
Covers out-of-network providers at in-network facilities.
Your cost is limited to your normal in-network deductible/copay.
Ground ambulances are a major exception and are not covered.
Uninsured? You have the right to a "Good Faith Estimate."
Introduction
As a healthcare project manager at BioLife, I spend my days focused on optimizing systems for better patient outcomes. But one of the biggest points of friction in American healthcare isn't a medical procedure—it's the bill that comes afterward. The No Surprises Act, which took effect on January 1, 2022, is a landmark piece of federal legislation created to tackle the deeply unfair practice of "surprise billing."[1] Even so, confusion remains. This guide will break down what the law does, who it protects, and what you need to do to ensure you're covered, using real-life scenarios to make it clear.
What Is a "Surprise Bill" and How Does the Act Protect You?
At its core, a "surprise bill," also known as balance billing, happens when you receive care from a provider or facility that is outside your health plan's network, and they bill you for the difference between what your insurance pays and what they charge.[2] This often occurs in situations where you have little or no choice.
The No Surprises Act makes this illegal in two key scenarios:
Emergency Services: If you have a medical emergency, you are protected. You can go to any emergency room, and the law ensures you can't be charged more than your standard in-network cost-sharing amounts (your copay, coinsurance, and deductible).[3] This protection extends to air ambulance services, but crucially, not ground ambulances.
Non-Emergency Services at In-Network Facilities: You chose an in-network hospital for your planned surgery, but the anesthesiologist who assisted was out-of-network. In the past, that anesthesiologist could send you a massive surprise bill. The Act now prohibits this. It protects you from out-of-network charges for services like anesthesiology, pathology, radiology, and more when you receive them at an in-network facility.[2]
Real-Life Scenario: Let's say Sarah has a bad fall and is rushed to the nearest hospital, which happens to be out-of-network. She needs emergency surgery. Before the Act, both the hospital and the surgeon could have billed her thousands of dollars beyond what her insurance covered. Now, under the No Surprises Act, the most Sarah can be billed is her plan's standard in-network deductible and copay for that surgery. Her insurance and the hospital must sort out the rest without involving her.
The Major Exception: Ground Ambulances
It's critical to understand what is not covered. While the Act includes protections for pricey air ambulance rides, it does not currently apply to ground ambulance services. This is one of the most common sources of surprise bills today. If you call an ambulance and it is not affiliated with your insurance network, you could still receive a large bill.
Know Your Rights: Consent and Waivers
In certain non-emergency situations, an out-of-network provider at an in-network facility can ask you to waive your protections. However, they must follow strict rules to do this.
They must give you a plain-language consent form at least 72 hours before the service.
The form must list the specific out-of-network provider and include a good-faith estimate of their charges.[4]
It must be clear that you are not required to sign it and can choose an in-network provider instead.
You can NEVER be asked to waive your rights for emergency services, or for ancillary services like anesthesiology, pathology, and radiology when provided at an in-network facility.[2] If anyone asks you to sign a form in these situations, it's a major red flag.
A Patient's Checklist: How to Use the Act
Being proactive is the best way to prevent billing headaches.
Before Scheduled Care:
Confirm the Facility is In-Network: Always double-check with your insurer that the hospital or surgical center is in your network.
Ask About Providers: When scheduling, ask if all providers involved (surgeon, anesthesiologist, labs) will be in-network. While the Act protects you if they aren't, being proactive can prevent a fight later.
Never Sign a Waiver Under Pressure: If you're handed a consent form to waive your rights, take your time. Remember, you have the right to find an in-network provider.
After Receiving a Bill:
Review Your Explanation of Benefits (EOB): Your insurance company will send you an EOB. Compare it carefully to the bill from the provider.
Look for "Out-of-Network" Language: If the bill is higher than your EOB suggests and you believe the Act protects you, don't just pay it.
Call Your Insurer First: They have a responsibility to adhere to the No Surprises Act. Explain the situation and ask them to re-process the claim correctly.
File an Appeal or Complaint: If the insurer or provider won't budge, you can file a complaint. The federal government has a portal and a phone number (1-800-985-3059) for this purpose.
Summary
The No Surprises Act is a powerful tool for patient financial protection, but it works best when you understand your rights. It effectively shields you from the most common and unavoidable types of surprise bills stemming from emergency care and out-of-network providers at in-network facilities. By understanding the rules, particularly the major exception for ground ambulances and the strict consent requirements, you can navigate the healthcare system with greater confidence and security.
Final Thought
From my perspective in healthcare systems, the No Surprises Act represents a critical step toward fairness and transparency. However, legislation is only as strong as its implementation and public awareness. As patients, our most powerful act is to be informed. Don't be afraid to ask questions, challenge bills that seem wrong, and use the protections you are guaranteed by law.
Frequently Asked Questions
What about patients who are uninsured? Does the Act help them?
Yes. A key provision for uninsured or self-pay patients is the right to receive a "Good Faith Estimate" (GFE) of expected charges before receiving scheduled non-emergency care.[1] This allows patients to understand costs upfront and helps prevent unexpected financial burdens.
Does the law apply if I have Medicare or Medicaid?
Individuals with Medicare and Medicaid already have protections against balance billing, so the No Surprises Act doesn't significantly change their coverage.[1] The Act primarily targets those with private insurance through an employer or the individual market.
What is the Independent Dispute Resolution (IDR) process I've heard about?
The IDR process is the backend mechanism for providers and insurers to resolve payment disputes without involving the patient. If an out-of-network provider and an insurer can't agree on a payment amount for a service covered under the Act, they enter this arbitration process to determine a fair price.
How do I find out if a doctor is in my network?
The most reliable way is to call your insurance company directly or use the provider directory on their official website. It's always best to verify, as provider networks can change and information from the doctor's office may not always be up-to-date.
My state has its own surprise billing law. Which one applies to me?
If a state has a law that provides similar or greater consumer protection than the federal No Surprises Act, the state law will generally apply. The federal law acts as a floor, not a ceiling, ensuring a baseline of protection for everyone.
References
Careviso. (2025, May 21). What Is the No Surprises Act? Retrieved from careviso.com
Adobe Benefits. (2025). No Surprises Act notice. Your Rights and Protections Against Surprise Medical Bills. Retrieved from Adobe.com
State of Indiana. (2025). Healthcare Reform: No Surprises Act. Retrieved from IN.gov
Penn Medicine. (2022). Rights and protections against surprise medical bills. Retrieved from PennMedicine.org
Heart Rhythm Society. (2024). New Patient Protections & Physician Obligations Under the No Surprises Act. Retrieved from hrsonline.org
About Paisley Zenith, PMI, MS
I'm a healthcare project manager and medical geneticist focused on optimizing medical processes and patient care systems at BioLife Health Research Center. My fascination with healthcare's future has been a driving force in my life, steering me towards a career in medical research. I'm excited to see what breakthroughs today will bring. Every day in this rapidly evolving field feels like stepping into the future. Follow me on LinkedIn.
