Overview
A surprise medical bill is an unexpected cost you get when you receive care from a doctor or hospital that is not part of your health insurance plan. This is often called a "balance bill." A balance bill happens when the provider charges you the difference between what they charge and what your insurance pays.
Important Note: If you choose to see a provider that is out of your insurance network on purpose, it is not a surprise medical bill.
How the No Surprises Act helps?
The No Surprises Act helps you in two main ways:
- Emergency Services: If you get emergency care at a hospital or from an ambulance, your insurance will pay for it right away, without needing approval. This works whether the provider is in your plan's network or not. (ground ambulance services are not covered.)
- Non-Emergency Services: If you go to a doctor who is in your network but get care from a doctor who is out of your network, your insurance will still pay for it like it would for an in-network provider.
In both cases, this law protects you from paying more than you would if all providers were in your network. The No Surprises Act also requires healthcare providers and facilities to give patients clear information about their billing rules, including what is covered and what is not.
What to Do If You Get a Surprise Bill
If you think you received a surprise bill and need help, fill out the No Surprises Bill Review Request Form(opens in a new tab). A special team will help you determine if you should pay the bill and how to resolve the issue. You should not pay more than you would have if the provider was in your network. It is the provider's job to know if a service is protected by the Act.
Check the 'Resources' section for more information, including answers to common questions and the No Surprises Bill Review Request Form.
If you have questions about your insurance or need to file a complaint with your insurance company, agent, broker, or public adjuster, visit our Consumer Help Center(opens in a new tab).