No Surprise Act

No Surprises Act

Your Rights and Protections Against Surprise Medical Bills

Learn how federal law protects you from unexpected medical charges

What Is “Balance Billing”?

When you receive medical care, you may owe certain out-of-pocket costs like a co-payment, coinsurance, or deductible. If you see a provider or visit a facility that isn’t part of your health plan’s network, you could also receive a bill for the difference between what your plan pays and what the provider charges — this is called balance billing or surprise billing.


Out-of-network costs are typically higher than in-network costs and may not count toward your annual out-of-pocket maximum.


When You Are Protected from Balance Billing

You are protected from balance billing in certain situations, including:


Emergency Services

If you have a medical emergency and receive care from an out-of-network provider or facility:

  • You can only be billed for your plan’s in-network cost-sharing amount (co-payments, coinsurance, or deductible).
  • You cannot be balance billed for emergency services, including post-stabilization care, unless you give written consent to waive your protections.


Services at In-Network Hospitals or Surgical Centers

When you receive care at an in-network hospital or ambulatory surgical center, some providers may be out-of-network. In these cases:

  • The most those providers may bill you is your in-network cost-sharing amount.
  • This protection includes services like anesthesia, pathology, radiology, laboratory, neonatology, assistant surgery, and hospitalist care.
  • These providers cannot ask you to waive your rights or agree to out-of-network billing.


You are never required to give up these protections or to seek care out-of-network. You always have the right to choose an in-network provider or facility.


Your Additional Rights

When balance billing isn’t allowed, you are only responsible for paying your share of the cost — just as you would if the provider were in-network.


Your health plan must:

  • Cover emergency services without prior authorization.
  • Cover emergency services by out-of-network providers.
  • Base your cost-sharing on the in-network rate and list this on your explanation of benefits.
  • Count any out-of-network emergency or protected service payments toward your deductible and out-of-pocket maximum.


If You Believe You’ve Been Wrongly Billed

If you believe you’ve been incorrectly billed or have questions about your rights under federal law, you can: