Surprise medical bills: your No Surprises Act protections

What's protected

• Emergency services, including care until you're stable enough to safely transfer.
• Non-emergency care from an out-of-network provider at an in-network facility — the ancillary clinicians you don't choose (anesthesia, radiology, pathology, assistant surgeon).
• Air ambulance transport.

What you actually owe

For protected services you owe only your in-network cost-sharing — the deductible, coinsurance, or copay you'd pay as if the care were in-network. The provider and the plan resolve the rest between themselves through open negotiation and, if needed, the federal independent dispute resolution process. You should not be asked to pay the difference between the provider's charge and the plan's payment.

Uninsured or self-pay: the good-faith estimate

If you're uninsured or paying out of pocket, the provider must give you a good-faith estimate of expected charges before scheduled care. If the final bill exceeds that estimate by at least $400, you can challenge it through the patient-provider dispute resolution process.

How to dispute a surprise bill

1. 1

   Confirm the service was protected

   Emergency care, an out-of-network provider at an in-network facility, or air ambulance fall under the law; ground ambulance generally does not.

2. 2

   Compare the bill to in-network cost-sharing

   You should owe only the in-network deductible/coinsurance/copay. Anything billed above that for a protected service is the issue.

3. 3

   Tell the provider and plan it violates the NSA

   State in writing that the balance bill is barred by the No Surprises Act and ask for a corrected bill and a reprocessed claim at in-network cost-sharing.

4. 4

   Escalate to the federal help desk or PPDR

   If it isn't resolved, file a complaint with the federal No Surprises Help Desk; if you're self-pay and the bill exceeds the good-faith estimate by $400+, use patient-provider dispute resolution.