For years, patients across the United States have faced a frustrating problem: getting hit with unexpected, high medical bills after receiving care — even when they went to an in-network hospital. These surprise bills often happen when you unknowingly receive treatment from an out-of-network provider during your visit.

To fix this, Congress passed the No Surprises Act (NSA), which took effect on January 1, 2022. Administered in part by the Centers for Medicare & Medicaid Services (CMS), the law gives patients new protections and tools to avoid these costly surprises.

Here's what you need to know, how it protects you, and how to use CMS resources to your advantage.

What Is the No Surprises Act?

The No Surprises Act is a federal law that bans most unexpected out-of-network medical bills for:

  • Emergency care at any hospital (even if it's out-of-network)
  • Non-emergency care at in-network hospitals if you're unknowingly treated by an out-of-network provider (such as an anesthesiologist or radiologist)
  • Air ambulance services (but not ground ambulances)

What This Means for Patients

Before the NSA, patients could be billed for the difference between what their insurer paid and what an out-of-network provider charged — a practice called balance billing.

Now:

  • You cannot be billed more than your in-network cost-sharing amount (deductible, copay, coinsurance) in most covered situations.
  • You must be given notice and consent if you're asked to receive care from an out-of-network provider in a non-emergency setting.
  • If you're uninsured or self-paying, you have the right to receive a Good Faith Estimate before care.

How the Good Faith Estimate Works

If you're uninsured or not using insurance for your care:

  • You can request a written estimate of your total charges before your service.
  • If your final bill is $400 or more above the estimate, you have the right to dispute it through the CMS Patient-Provider Dispute Resolution Process.

How to Use CMS Resources to Protect Yourself

CMS offers a variety of tools to help you understand your rights and take action if you receive a surprise bill:

Understand Your Rights

Visit the official CMS No Surprises Act webpage for plain-language explanations of the law and your protections.

File a Complaint

If you believe you've been wrongly billed, you can file a complaint online or by calling 1-800-985-3059. You must do this within 120 days of receiving the bill.

Get Help with a Dispute

Use the Patient-Provider Dispute Resolution Process if your bill is much higher than your Good Faith Estimate.

Find State Resources

CMS lists state-specific programs and departments that can help you resolve billing issues.

When the No Surprises Act Doesn't Apply

The NSA does not cover:

  • Ground ambulance services (costs vary widely by state)
  • Care from out-of-network providers that you knowingly choose and agree to pay for in advance
  • Certain types of non-covered services under your health plan

Final Takeaway: You Have More Power Than You Think

The No Surprises Act is a major win for patients, removing one of the most unfair financial traps in healthcare. By understanding your rights, asking for Good Faith Estimates, and using CMS resources, you can avoid surprise bills and fight back when they occur.