The No Surprises Act (NSA), effective January 1, 2022, limits surprise medical bills in specific situations. It doesn't cap all out-of-network costs — but it closes the most common billing traps: surprise ER bills from out-of-network physicians and unexpected charges from providers you didn't choose.

What the No Surprises Act covers

1. Emergency services

If you go to any ER — in-network or out-of-network — and receive emergency care, out-of-network providers cannot charge you more than your in-network cost-sharing (deductible, copay, coinsurance). This includes ER physicians, radiologists, anesthesiologists, and other providers at the ER, even if they are not in your network.

2. Non-emergency care at in-network facilities

If you're at an in-network hospital for a scheduled procedure and receive care from an out-of-network provider you didn't choose (common examples: anesthesiologist, assistant surgeon, radiologist), that provider cannot balance-bill you above your in-network cost-sharing — unless they gave you written notice at least 72 hours before and you signed a consent form agreeing to out-of-network charges.

3. Air ambulance

Ground ambulance is excluded, but air ambulance services from non-participating providers are covered by the NSA's surprise billing protections.

4. Good Faith Estimates for uninsured patients

Providers must give uninsured or self-pay patients a Good Faith Estimate at least 3 business days before any scheduled service. If the final bill exceeds this estimate by more than $400, you can dispute it.

What the No Surprises Act does NOT cover

  • Out-of-network care at an out-of-network facility you chose to visit
  • Ground ambulance services
  • Routine billing errors, upcoding, or overcharges unrelated to network status
  • Dental or vision services (separate insurance)
  • Short-term health plans, grandfathered health plans, or most sharing ministries

How to use the No Surprises Act

  1. Identify the provider type. If you received a bill from a physician you didn't select (anesthesiologist, radiologist, hospitalist) while at an in-network facility, it may be a surprise bill covered by the NSA.
  2. Check that the bill isn't already NSA-compliant. Insurers should apply NSA protections automatically. If they didn't, call your insurer first.
  3. File a complaint with CMS if the insurer or provider won't apply NSA protections.
  4. Request the Good Faith Estimate before any scheduled procedure if you're uninsured.
  5. Still audit your bill for other errors. The NSA protects against surprise network charges but does nothing about duplicate charges, upcoding, or overpriced line items.
Bottom line: The No Surprises Act closes the most common surprise billing trap — unexpected out-of-network charges at in-network facilities and ER visits. But it doesn't fix the underlying pricing problem. Still audit your bill for errors regardless of network status.