What Is the No Surprises Act? Your Guide to Ending Unexpected Medical Bills in 2025

Imagine this, you go to the emergency room, thinking your insurance has you covered. Weeks later, you get a jaw-dropping bill for thousands of dollars, all because the doctor who treated you was out-of-network. Sound familiar? That’s exactly the kind of financial trap the No Surprises Act was created to eliminate.

Effective January 1, 2022, the Federal No Surprise Billing Act protects millions of Americans from costly and unfair surprise medical bills. Whether you’re covered through your job, the Marketplace, or you self-pay, this law ensures you’re not stuck with unexpected costs from out-of-network providers, especially during emergencies or when receiving care at in-network facilities.

In this article, we’ll break down exactly who the No Surprises Act applies to, how it works, what your rights are, and how it plays out across different U.S. states. If you’ve ever felt blindsided by a medical bill, this blog is for you.

Why Was the No Surprises Act Created?

Before the No Surprises Act, it wasn’t uncommon for patients to receive unexpected bills after a medical emergency or hospital visit, even if they visited an in-network facility. That’s because many hospitals work with third-party providers like anesthesiologists or radiologists who may not be in your insurance network.

When those providers billed at full out-of-network rates, the patient was responsible for the difference. This practice, called balance billing, could result in financial devastation for families already dealing with a health crisis.

To combat this, the federal government passed the No Surprises Act as part of the Consolidated Appropriations Act of 2021. It aims to standardize protections nationwide and stop this kind of billing abuse.

Who Does the No Surprises Act Apply To?

The No Surprises Act applies to most people with private health insurance, including:

Employer-sponsored plans
Health Insurance Marketplace plans
Individual and family plans purchased directly from insurers

It also protects uninsured and self-pay patients by requiring providers to give a Good Faith Estimate of expected charges before non-emergency services are delivered.

Already protected under other programs? If you have Medicare, Medicaid, TRICARE, VA health care, or receive care through Indian Health Services, you already enjoy similar protections and the No Surprises Act does not apply to you.

However, it does not apply to:

Short-term health plans
Standalone dental or vision insurance
Retiree-only plans
Health plans that are not regulated under federal law

What Is a Surprise Medical Bill?

A surprise medical bill is exactly what it sounds like: a bill for healthcare services you didn’t expect to receive or didn’t expect to be so expensive. This usually happens when:

You’re treated by an out-of-network provider during an emergency
You visit an in-network hospital, but an out-of-network specialist is involved in your care (like an anesthesiologist or radiologist)
You receive air ambulance services from an out-of-network provider

In these cases, patients were often balance billed for the difference between what their insurance paid and what the provider charged. The No Surprises Act bans balance billing in most of these scenarios.

What Protections Does the No Surprises Act Offer?

The law introduces several major consumer protections across three key scenarios:

Emergency Care Protections

You cannot be charged more than your in-network rate, even if the ER or doctor is out-of-network
You do not need prior authorization for emergency services

Non-Emergency Services at In-Network Facilities

If you’re at an in-network hospital and receive care from an out-of-network provider (e.g., anesthesiologist), you can’t be balance billed
Exceptions exist if the provider gives you advance notice and you sign a consent form (this is called “notice and consent”)

Air Ambulance Services

The Act protects patients from surprise air ambulance bills
However, ground ambulance services are not federally protected, though some states have their own rules

Good Faith Estimates for Self-Pay Patients

If you’re uninsured or paying without insurance:

Providers must give you a Good Faith Estimate before scheduled care services are not federally protected, though some states have their own rules
You can dispute bills that are more than $400 above the estimate through the federal resolution process

How to Dispute a Surprise Medical Bill?

If you receive a bill that seems higher than expected or violates the law:

Compare the bill with your Explanation of Benefits (EOB)
Check if the provider gave you a Good Faith Estimate
If you’re charged more than $400 above the estimate, you can file a dispute within 120 days of receiving the bill
Contact the No Surprises Help Desk at 1-800-985-3059

State-Specific Balance Billing Protections

While the Federal No Surprises Act offers nationwide protection, many U.S. states have passed their own surprise billing laws. These state laws may offer broader or stronger safeguards than the federal standard, and in such cases, state rules take precedence.

If you’re wondering whether your state provides additional protection against balance billing or has its own dispute resolution process, this table breaks it down for you.

State-by-State Summary of Surprise Billing Laws

State	Protections	More Info
Arizona	Covers emergency and non-emergency services from out-of-network providers; includes a consumer dispute resolution process.	difi.az.gov
California	Prohibits balance billing for emergency and non-emergency services by out-of-network providers at in-network facilities; comprehensive protections.	dmhc.ca.gov
Colorado	Strong protections for emergency and non-emergency services; includes air ambulance services; uses an arbitration process.	doi.colorado.gov
Connecticut	Extensive protections against surprise bills for emergency and non-emergency services; state-managed dispute resolution.	https://portal.ct.gov/cid?language=en_US
Florida	Covers emergency and non-emergency care with out-of-network providers at in-network facilities; includes a state dispute resolution system.	floir.com
Illinois	Protects consumers in PPO and HMO plans from surprise bills for emergency services and certain non-emergency services.	https://idoi.illinois.go/
Iowa	Covers out-of-network emergency services; limited protections for non-emergency care.	iid.iowa.gov
Maryland	Extra protections for HMO and PPO enrollees, including restrictions on ground ambulance balance billing and assignment of benefits protections.	https://www.marylandattorneygeneral.go/
Massachusetts	Emergency and non-emergency services covered; includes provider disclosure requirements and dispute resolution process.	mass.gov
Michigan	Outlaws balance billing for emergency services; protects patients from non-emergency balance billing in some cases.	https://www.michigan.gov/som
Minnesota	Comprehensive protections against balance billing for emergency and non-emergency services at in-network facilities.	ag.state.mn.us
New Jersey	Strong laws covering emergency and inadvertent out-of-network care; includes arbitration process for disputes.	https://www.nj.gov/
New York	One of the most robust state laws; covers emergency and surprise bills from out-of-network providers and includes independent dispute resolution.	dfs.ny.gov
North Carolina	Emergency services protected under federal law; limited state-level protections; federal law primarily applies.	ncdoi.gov
Oregon	Covers emergency and non-emergency care at in-network facilities from out-of-network providers; prohibits balance billing.	https://www.oregon.gov/dcbs/about/divisions-programs/pages/dfr.aspx
Texas	Includes arbitration and mediation processes; applies to both emergency and certain non-emergency services; strong enforcement policies.	tdi.texas.gov
Washington	Comprehensive law prohibits surprise billing for emergency and non-emergency services at in-network facilities; includes dispute resolution.	insurance.wa.gov
Wisconsin	No specific state law banning balance billing; relies entirely on federal No Surprises Act protections.	oci.wi.gov

Notice and Consent: When Can You Waive Your Protections?

While the No Surprises Act bans balance billing in most cases, there are limited situations where a provider may ask you to waive your protections. This is done through a process called notice and consent.

When Notice and Consent Can Be Used:

Non-emergency services scheduled in advance with an out-of-network provider at an in-network facility
Post-stabilization services after an emergency (once you are stable)

In these cases, you must:

Receive a clear, written notice explaining your rights
Be given an estimate of the expected costs
Sign the form at least 72 hours before the procedure

Important: You are not obligated to sign. If you decline, you can request care from an in-network provider instead.

When Notice and Consent Cannot Be Used:

Emergency care
Ancillary services (e.g., anesthesia, pathology, radiology)
Services where no in-network provider is available
Urgent or unforeseen care needs

What the No Surprises Act Doesn’t Cover

While the law offers broad protections, it doesn’t cover every scenario. Here’s what remains outside the scope of the No Surprises Act:

Ground ambulance services (in most states, though Maryland and others have some protections)
Out-of-network non-emergency care at out-of-network facilities
Services not covered by your insurance plan.
Plans not regulated by federal law, such as:
- Short-term limited duration plans
- Standalone dental/vision plans
- Retiree-only plans

Always check with your insurance provider or state insurance department for plan-specific and state-specific coverage questions.

Federal No Surprise Billing Act vs State Laws

The Federal No Surprises Act sets a nationwide minimum for consumer protection, but many states have passed their own laws that offer even stronger safeguards. When both laws apply, the one that offers greater protection takes precedence.

Comparison Table:

Feature	Federal No Surprise Billing Act	State Laws
Emergency care protections	✅ Yes	✅ Varies by state (some stronger)
Ancillary services protections	✅ Yes	✅ Some states go further
Air ambulance services	✅ Yes	❌ Few states have laws
Ground ambulance services	❌ Not covered	✅ Only a few states (e.g. MD)
Good faith estimates	✅ Yes	✅ Some states expand access
Independent dispute resolution	✅ Federal system	✅ Some use state-level process

What to Do If You Receive a Surprise Medical Bill

If you believe you’ve been wrongly billed or charged more than expected, here’s a simple step-by-step guide to protect your rights:

1. Review your Explanation of Benefits (EOB):

Confirm what your insurance covers and how much you owe.

2. Compare it to your bill:

Look for services that might be out-of-network or charged incorrectly.

3. Check for a Good Faith Estimate (if applicable):

If your bill is $400+ over the estimate, you can dispute it.

4. Call the provider’s billing office:

Ask for clarification or negotiate a reduction.

5. Contact the No Surprises Help Desk:

📞 Call 1-800-985-3059 (8 a.m. – 8 p.m. ET, 7 days/week)

6. File a complaint online:

Visit: CMS Medical Bill Rights

The Bottom Line

The No Surprises Act is a major win for healthcare transparency and patient rights. Whether you’re privately insured, self-paying, or just trying to avoid another unexpected bill, this law empowers you to:

Make informed decisions
Avoid predatory billing practices
Hold providers accountable

By understanding who the No Surprises Act applies to, when it does and doesn’t protect you, and how your state’s laws come into play, you’re better equipped to manage your healthcare with confidence and peace of mind.

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