No Surprises Act

Your rights and protections against surprise medical bills

Your Right to a Good Faith Estimate

Under the No Surprises Act, which went into effect on January 1, 2022, health care providers are required to give patients who don't have insurance or who are not using insurance an estimate of the expected charges for services.

What You're Entitled To

You have the right to receive a Good Faith Estimate explaining how much your therapy services will cost. This applies to you if you:

  • Do not have health insurance
  • Have insurance but choose not to use it (self-pay)
  • Are seeking services from an out-of-network provider

This estimate should be provided to you in writing at the time of scheduling — or when you ask about the cost of services.

Dispute Resolution: If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. You may contact the U.S. Department of Health and Human Services (HHS) at (800) 985-3059 to learn more about the dispute resolution process.

Make sure to save a copy of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.

Your Protections Against Surprise Medical Bills

When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing — also known as "balance billing."

What Is Balance Billing?

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, or deductible. You may have additional costs — or have to pay the entire bill — if you see a provider or visit a health care facility that isn't in your health plan's network.

"Out-of-network" describes providers and facilities that haven't signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called "balance billing."

This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit. "Surprise billing" is an unexpected balance bill — this can happen when you can't control who is involved in your care, such as during an emergency or when you are unexpectedly treated by an out-of-network provider.

You Are Protected from Balance Billing For:

Emergency Services

If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan's in-network cost-sharing amount (such as copayments and coinsurance). You can't be balance billed for these emergency services. This includes services you may get after you're in stable condition, unless you give written consent and give up your protections not to be balance billed for these post-stabilization services.

Certain Services at an In-Network Hospital or Ambulatory Surgical Center

When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan's in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can't balance bill you and may not ask you to give up your protections not to be balance billed.

If you get other services at these in-network facilities, out-of-network providers can't balance bill you unless you give written consent and give up your protections.

You're never required to give up your protections from balance billing. You also aren't required to get care out-of-network. You can choose a provider or facility in your plan's network.

When Balance Billing Isn't Allowed

When balance billing isn't allowed, you also have the following protections:

  • You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
  • Your health plan generally must cover emergency services without requiring you to get approval for services in advance (prior authorization).
  • Your health plan generally must cover emergency services by out-of-network providers.
  • Your health plan generally must base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility, and show that amount in your explanation of benefits.
  • Your health plan generally must count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

Questions or Concerns?

If you believe you've been wrongly billed, you may contact the U.S. Department of Health and Human Services (HHS).

No Surprises Help Desk: (800) 985-3059

Visit www.cms.gov/nosurprises for more information about your rights under this law.