# What is the No Surprises Act? The No Surprises Act provides federal protections against most surprise medical bills and prohibits providers from billing patients more than the in-network cost-sharing amount. It outlines a dispute process for surprise medical bills and establishes a patient-provider dispute resolution process for uninsured individuals to determine correct payment amounts. The [No Surprises Act](https://www.cms.gov/newsroom/fact-sheets/no-surprises-understand-your-rights-against-surprise-medical-bills) took effect January 1, 2022, providing federal protections against surprise medical bills from out-of-network providers and facilities. Providers are banned from billing more than in-network cost-sharing amounts, and the act also established a federal [dispute resolution process](/content/post/how-to-fight-or-dispute-a-surprise-medical-bill-and-win-advice-from-a-former-hospital-administrator/index.html) if your bill does not reflect the estimated charges. ## The No Surprise Act The [No Surprises Act](https://www.cms.gov/nosurprises) took effect in January of 2022. This act prohibits providers from billing patients more than the in-network cost-sharing amount and outlines a dispute process for surprise medical bills. The Congressional Budget Office estimates the act will reduce federal health spending by [$17 billion](https://www.healthaffairs.org/do/10.1377/forefront.20211028.424036/full/) over the next ten years. Most adults worry about unexpected medical bills. Approximately [60 percent](https://www.beckershospitalreview.com/finance/93-of-americans-who-negotiate-medical-bills-get-them-reduced-or-eliminated-study-finds.html) of Americans have been in debt from medical bills totaling at least [$140 billion](https://siepr.stanford.edu/news/americas-medical-debt-much-worse-we-think) nationwide. The new federal protections will apply to most surprise bills for emergency and non-emergency services provided at in-network facilities. ### What is Surprise Medical Billing Surprise medical billing can occur when a patient receives out-of-network services during an emergency visit or from a provider at an in-network hospital without advance notice. This law prohibits providers from billing patients more than the in-network cost-sharing amount and [allows](https://www.kff.org/health-costs/press-release/the-no-surprises-act-begins-january-2022-this-is-what-you-can-expect/) consumers to appeal disputes over coverage of surprise medical bills to an external reviewer. If you want an out-of-network doctor to be part of your care, the law requires that the doctor notifies you at least three days prior to your procedure, with a “good faith estimate” of how much you will be charged at the time of service. ### Good-Faith Estimate The No Surprises Act entitles patients to a “good faith estimate” before their appointment. A good faith estimate applies to non-emergent care. The facility must provide the good faith estimate within one business day if the patient schedules care at least three business days in advance. Each good faith estimate [must include](https://www.healthaffairs.org/do/10.1377/forefront.20211001.811063/full/) the following information: - Patient’s name and date of birth - A description of the primary item or service - An itemized list of items or services that are reasonably expected to be provided - Diagnosis codes and expected charges - A list of services or items that will require separate scheduling - Disclaimers, including information on the availability of the patient/provider dispute resolution process ## How to Appeal a Surprise Medical Bill An uninsured or self-pay patient is eligible for the patient/provider dispute resolution process if their total billed charges are at least [$400 more](https://www.cms.gov/newsroom/fact-sheets/requirements-related-surprise-billing-part-ii-interim-final-rule-comment-period) than the expected charges listed on the patient’s good faith estimate. To initiate the dispute resolution process, the self-pay individual must notify HHS within 120 calendar days of receiving the initial bill and include: - Information about the item or service in dispute - A copy of the invoice - A copy of the good faith estimate - The provider’s contact information You must submit this information through the [federal independent dispute resolution (IDR) portal](https://www.dfs.ny.gov/IDR) and pay an administrative fee of no more than $25. There are two [steps](https://www.healthcare.gov/appeal-insurance-company-decision/external-review/) in the external review process: 1. **You file an external review**: You must file a written request for an external review within four months after receiving a notice from your insurer that your claim has been denied. 2. **Final decision**: An external review either upholds your insurer’s decision or decides in your favor. ## What the No Surprises Act Does NOT Do The No Surprises Act does not guarantee that you will never get a surprise medical bill again. If you have an insurance plan with a high deductible or coinsurance, you could still get a large bill. ## States with Dispute Resolution Processes Some states have already established dispute resolution systems for uninsured patients under each state’s surprise billing laws. HHS acknowledges these existing laws and confirms that HHS will defer to state processes that meet or exceed the NSA’s standards. ## No Surprises Act Frequently Asked Questions (FAQs) ### How is the No Surprise Act different from Healthcare Price Transparency? The Transparency in Coverage rules primarily apply to those with health insurance and require displaying estimated costs of healthcare services. The No Surprises Act offers federal protections to those with or without health insurance. ### Does the No Surprises Act impact those without insurance? Yes, the No Surprises Act includes protections for the uninsured. ### What if the bill ends up being less than the estimate? If the billed charge is equal to or less than the expected charge, the patient pays the billed charge. ### How long does the external review process take? Standard external reviews are decided no later than 45 days after receiving the request. Expedited external reviews are resolved within 72 hours. ### What happens to the initial administrative fee if the patient wins the dispute? If the provider loses the dispute, the facility must reduce the amount the patient owes to account for this fee. ## Bottom Line The No Surprises Act (NSA) aims to improve healthcare cost transparency by requiring healthcare facilities to provide the estimated cost of services and treatment for an upcoming visit, along with a federal dispute resolution process should the medical bill not match the expected cost of the visit.