The No Surprises Act Can Protect You From Some Medical Bills — But Not Every Bill Qualifies

The No Surprises Act helps protect patients from unexpected, and potentially high, medical bills.

But there are still surprises you can incur when medical expenses are involved, and knowing the possibilities can leave you better prepared. Here's what you need to know.

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What the No Surprises Act protects you from

The No Surprises Act prevents healthcare providers from charging patients higher out-of-network cost-sharing because the doctor, hospital or other covered provider was outside of the insurer’s network. It also safeguards you from surprise costs for certain non-emergency services performed by out-of-network providers at an in-network hospital. You typically just pay what you would have owed for in-network care. Air ambulances are also covered by federal surprise-billing protections.

These protections can vary or be supplemented by state law, but they are ultimately designed to prevent patients from having to deal with out-of-network complexities. That way, you won’t be responsible for the gap between what your insurance covers and what an out-of-network provider charges. This balance billing protection only applies to eligible expenses.

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The medical bills that can still surprise you

Although the No Surprises Act offers many safeguards, it doesn’t protect you from every surprise. For instance, ground ambulance bills are not included in the No Surprises Act, but it has emerged as a significant concern that policymakers are discussing.

Your final bill can still exceed the good faith estimate, so it is possible to receive a higher expense than expected. A high bill isn’t always an unlawful bill, especially when deductibles, co-insurance or uninsured services are involved. You may also face a higher bill than expected if you deliberately pursued an out-of-network healthcare provider.

What to do if you think a bill violates the law

If you think your rights have been violated, you can contact the federal No Surprises Help Desk or submit a complaint to the Centers for Medicare & Medicaid Services. The issue will be pushed forward, and if there is a legitimate dispute, you can receive compensation.

In some cases, state insurance regulators and consumer assistance programs are also worth contacting. These entities are more useful in states that have additional legal consumer protections from surprise billing practices. Knowing your rights and disputing when necessary can help you save money in the long run.