The No Surprises Act in 2025: What Patients Need to Know
Few things are more frustrating than receiving a massive medical bill you weren't expecting—especially after you thought you did everything right by going to an in-network hospital and having good insurance coverage.
For years, patients faced "surprise billing" when they unknowingly received care from out-of-network providers, often during emergencies or routine procedures at in-network facilities. The No Surprises Act, which took effect in January 2022, was designed to protect patients from these unexpected bills.
What Is the No Surprises Act?
The No Surprises Act is federal legislation that limits when patients can be balance-billed for out-of-network care. Balance billing happens when an out-of-network provider bills you for the difference between what they charge and what your insurance pays.
Before this law, you could go to an in-network hospital for surgery and still receive surprise bills from the anesthesiologist, the assistant surgeon, the radiologist, or other providers you never chose—simply because they happened to be out of network.
What the Law Protects You From
The No Surprises Act provides protection in specific situations:
Emergency Services
If you receive emergency care, you cannot be balance-billed by out-of-network providers or facilities. This applies whether you go to an in-network or out-of-network emergency department.
Why this matters: In an emergency, you can't shop around for in-network providers. You go to the nearest hospital. This protection ensures you won't face massive bills because the emergency room or providers who treated you were out of network.
Example: You have a heart attack and are taken to the closest emergency room, which happens to be out of network. Under the No Surprises Act, you can only be charged your in-network cost-sharing amount (your deductible, copay, or coinsurance).
Non-Emergency Services at In-Network Facilities
When you receive planned (non-emergency) care at an in-network hospital or facility, you're protected from surprise bills from out-of-network providers.
Why this matters: You can't control which anesthesiologist, pathologist, radiologist, or assistant surgeon is available during your procedure. You shouldn't face surprise bills for providers you didn't choose.
Example: You schedule surgery at your in-network hospital. The anesthesiologist assigned to your case is out of network. Previously, you could receive a surprise bill for thousands of dollars. Now, you're protected.
Air Ambulance Services
The law protects you from surprise bills for out-of-network air ambulance services.
Why this matters: Ground ambulances are unfortunately NOT covered by this law, but air ambulances are included.
Example: You're seriously injured in a remote area and need an air ambulance to a trauma center. Even if the air ambulance service is out of network, you can't be balance-billed beyond your in-network cost-sharing.
What You Can Be Charged
Under the No Surprises Act, you can only be charged:
- Your in-network deductible
- Your in-network copay
- Your in-network coinsurance
These amounts count toward your in-network out-of-pocket maximum, not your out-of-network maximum.
Important Exceptions and Limitations
The No Surprises Act doesn't cover everything:
Ground ambulances: The law doesn't protect against surprise bills from ground ambulances—one of the most common sources of surprise medical bills.
When you consent: If you receive advance notice and consent in writing to receive care from an out-of-network provider at an in-network facility, you can be balance-billed. However, this consent can't be obtained in emergency situations.
Out-of-network facilities: If you voluntarily choose to go to an out-of-network facility for non-emergency care, the protections don't apply.
How to Use Your Rights
Before Scheduled Procedures
Ask these questions:
- Is this facility in my network?
- Will all providers involved in my care be in-network?
- If any provider is out-of-network, am I being asked to consent to balance billing?
Know that: Facilities should not ask you to waive your rights under the No Surprises Act for ancillary services (anesthesiology, radiology, pathology, etc.).
If You Receive a Surprise Bill
If you receive a bill that seems to violate the No Surprises Act:
Step 1: Contact the provider's billing department and explain that you believe the bill violates the No Surprises Act.
Step 2: Contact your insurance company and ask them to review the bill.
Step 3: If the issue isn't resolved, file a complaint with the federal government at cms.gov/nosurprises or call 1-800-985-3059.
The Good Faith Estimate
The No Surprises Act also requires providers to give you a "good faith estimate" of costs when you schedule services or when you request one for a non-emergency service.
This estimate should include:
- Expected charges from your provider
- Expected charges from other providers involved in your care
- Expected charges for items and services
Important: This applies to all patients, even those without insurance. Uninsured or self-pay patients can also request good faith estimates.
Provider-Insurance Disputes
When an out-of-network provider and your insurance company can't agree on payment, the No Surprises Act provides an independent dispute resolution process. Importantly, you are not part of this dispute—you're protected regardless of how it's resolved.
Real-World Impact
Since the law took effect in 2022, millions of patients have been protected from surprise bills. However, enforcement and awareness remain challenges.
Some patients still receive surprise bills because:
- They're unaware of their rights
- Providers don't fully comply with the law
- The billing situation falls outside the law's protections (like ground ambulances)
- There's confusion about what qualifies for protection
What to Do If You're Unsure
If you receive a medical bill and aren't sure whether it violates the No Surprises Act:
Don't pay immediately. Take time to review the bill and understand your rights.
Review your EOB. Check your Explanation of Benefits from insurance to see how they processed the claim.
Contact your insurance company. Ask whether the bill complies with the No Surprises Act.
Get help. Patient advocates, your state's consumer protection office, or services that specialize in medical billing can help you understand whether you're being properly charged.
Some families use claim monitoring services that automatically review bills for compliance with laws like the No Surprises Act. Services like HealthLock can alert you to improper charges and help you challenge them.
Ongoing Developments
The No Surprises Act continues to evolve. Regulations are being refined, enforcement is improving, and there are ongoing discussions about expanding protections to ground ambulances.
Stay informed about your rights, as protections may expand in the future.
The Bottom Line
The No Surprises Act provides important protections against unexpected medical bills in emergency situations and when receiving care at in-network facilities. While it doesn't cover every scenario, it's a significant step toward protecting patients from bills they can't control.
Know your rights under this law. If you receive a surprise bill that seems wrong, don't assume you have to pay it. Question it, understand your protections, and take action if necessary.
The law is only as powerful as patients' willingness to use it. When you enforce your rights, you're not just protecting yourself—you're helping ensure the law works as intended for everyone.
Stay Protected
While the No Surprises Act provides important protections, enforcement isn't automatic. HealthLock monitors your claims for surprise bills and other violations, alerting you to problems so you can exercise your rights under the law. HealthLock's members have saved over $243 million by catching billing errors, denied claims, and fraud before they became major problems.
Disclaimer: We're not medical billing experts or attorneys—we're patients and caregivers sharing resources to help you navigate a broken system. This information is for educational purposes only and should not be considered medical or legal advice.
Affiliate Disclosure: This site may contain links to services like HealthLock that help monitor medical claims and billing. We may earn a commission if you sign up through our links, at no extra cost to you. We only recommend services we believe can genuinely help.