Patient guide · 9-min read
A Plain-English Guide to the No Surprises Act (2022)
The No Surprises Act ended a decade of advocacy by capping patient liability when an out-of-network provider treats you at an in-network facility. Here is how to use it.
What the NSA does
Effective January 2022, the No Surprises Act (Pub. L. 116-260, Div. BB, Title I; 42 U.S.C. § 300gg-111 et seq.) prohibits balance-billing for: (a) emergency services at any facility, (b) non-emergency services from out-of-network providers at in-network facilities, and (c) air ambulance. Patient liability is capped at the in-network cost-sharing amount.
What it does not cover
Ground ambulance was excluded from the initial NSA. Urgent-care facilities are not covered (only true ERs). And the protection can be waived by signing a specific NSA disclosure at least 72 hours before a scheduled procedure — but emergency and ancillary services (anesthesia, radiology, pathology, hospitalist, neonatology, assistant surgeon) can never have NSA protection waived.
How to invoke the NSA
When you receive a surprise out-of-network bill, the dispute letter asserts NSA protection, identifies the provider and line items, and demands the charges be reduced to in-network cost-sharing. If the facility refuses, file a federal complaint at 1-800-985-3059 or via cms.gov/nosurprises — there is no fee and they will contact the provider.
The independent dispute resolution process
If the insurer and the out-of-network provider dispute the appropriate reimbursement, they enter a federal IDR process. You as the patient are not party to that dispute and never owe more than the in-network cost-share regardless of how IDR resolves.
Frequently asked
Does the NSA apply to dental?
Not directly. NSA applies to medical and air-ambulance services. Some states have parallel dental surprise-billing laws.
How long does an NSA complaint take?
Federal complaints typically receive an initial response within 30 days. Many providers adjust the bill simply on receipt of the complaint.