The No Surprises Act, which took effect on January 1, 2022, bans surprise balance bills for emergency care, certain non-emergency services at in-network hospitals and surgical centers, and air ambulance transport. You cannot be charged more than your plan's in-network cost-sharing amounts (copayments, coinsurance, or deductibles) for these covered services, even when an out-of-network provider delivers the care. The law applies to all private health insurance plans with policy years starting January 1, 2022 or later. It protects you from unexpected bills when you need emergency care or when you use an in-network facility but receive treatment from an out-of-network provider—a common scenario in hospitals where radiologists, anesthesiologists, or lab technicians operate outside your insurance network.
Table of Contents
- Emergency Care Is Protected Without Notice
- Non-Emergency Services at In-Network Facilities
- You Pay Only Your In-Network Cost-Sharing
- Know What the Act Does Not Protect
- Frequently Asked Questions
Emergency Care Is Protected Without Notice
When you receive emergency care from an out-of-network provider at a hospital or freestanding emergency department, balance billing is prohibited. The protection extends through post-stabilization care until you can consent and safely transfer to an in-network facility without additional balance bills. This means an out-of-network emergency physician, for example, cannot charge you more than your plan's standard emergency copayment, and your health plan must pay any amount beyond that directly to the provider.
Non-Emergency Services at In-Network Facilities
If you schedule care at an in-network hospital or surgical center, the Act bans balance billing for ancillary services—radiology, laboratory, anesthesia, pathology, and neonatology—furnished by out-of-network providers, as long as you haven't received written advance notice and consent. This protection applies without exception; you cannot waive it even if you want to. Many patients do not know which specialists at a hospital are out-of-network until after the procedure, so this rule protects you from discovering that surprise after a bill arrives.
You Pay Only Your In-Network Cost-Sharing
Your responsibility is limited to whatever in-network cost-sharing your plan requires—your copayment, coinsurance, or deductible. The health plan must pay the difference between your cost-sharing amount and what the out-of-network provider bills. This shifts the negotiation over payment rates away from you and onto your insurer, which has more leverage to dispute unreasonable charges.
Know What the Act Does Not Protect
The law has important gaps. Ground ambulances are not covered by the federal No Surprises Act, although 22 states have enacted their own ground ambulance protections for fully insured plans. Air ambulances (helicopter and fixed-wing) are protected. If you need an ambulance, ask the dispatcher whether your state offers ground ambulance protections and whether your plan is fully insured or self-funded; self-insured employer plans receive no state-level ground ambulance coverage.
Additionally, you can give written consent to waive the Act's protections for non-ancillary non-emergency services and post-stabilization care, meaning you can agree in advance to pay out-of-network rates for elective procedures. Ancillary services—the radiology, lab work, and anesthesia during a procedure—cannot be waived. If you are asked to sign consent to out-of-network charges, read it carefully and ask which services it covers.
Frequently Asked Questions
Does the No Surprises Act apply to self-insured employer plans?
Yes, the Act applies to all private health insurance plans with policy years starting January 1, 2022 forward. However, ground ambulance protections exist only at the state level and do not apply to self-insured plans in most states.
Can I be balance-billed if I know a provider is out-of-network and schedule care anyway?
For emergency care, no—the Act protects you regardless of network status. For non-emergency care, you can sign written consent to waive protections and accept out-of-network charges, but your provider must give you written notice and consent first.