The No Surprises Act took effect January 1, 2022. It is the single biggest patient protection passed in the last decade, and it’s under-used by patients who don’t know it exists.
What it covers
- Out-of-network emergency services, including stabilization until the patient can be safely transferred. ER visits, period — no surprise OON bill, regardless of which hospital.
- Out-of-network ancillary services at an in-network facility — anesthesia, pathology, radiology, hospitalists, neonatology, lab. If the hospital is in-network, the OON anesthesiologist who showed up to your in-network surgery cannot balance bill you.
- Out-of-network air ambulance. Ground ambulance is not covered (a notable gap).
What it requires of patients
You owe the in-network cost-share — your normal deductible and coinsurance for an in-network claim. Anything above that is the providers’ problem to settle through the Independent Dispute Resolution (IDR) process. You don’t mediate; the law does it for you.
How we use it
The NSA is one of the most useful statutes to cite in out-of-network bill disputes. The pattern is almost always the same: in-network hospital, OON specialist, big bill. You file the appeal and cite the statute — and because the law is unambiguous, the insurer’s claims department often can’t defend a contrary position.
What it doesn’t cover
Care you scheduled in advance with an OON provider after a written notice-and-consent form. Ground ambulance, in most states. Self-pay arrangements outside insurance. Knowing the gaps matters as much as knowing the protections.