The short version
The federal No Surprises Act protects you when you get emergency care, or care at an in network hospital, from a provider you did not choose who turns out to be out of network. In those cases your cost sharing is capped at your in network rate, and the provider cannot bill you for the difference. If a bill ignores that, it is worth disputing before anything is paid.
Run the triage check, freeAnswer a few questions about the bill. The triage flags whether this protection likely applies.
What the law covers
- Emergency services, including at out of network hospitals, capped at your in network cost.
- Care at an in network facility from out of network providers you did not pick, like anesthesiologists, radiologists, and labs.
- Air ambulance services.
The gap nobody warns about
Ground ambulances are not covered by the federal law. An air ambulance bill and a ground ambulance bill look the same in the mailbox, but only one of them carries the federal cap. Some states have closed the ground ambulance gap with their own laws, so check your state's rule or call the help desk before paying.
What to do with a bill that breaks the rule
- Do not pay the overage. Pay, at most, your in network cost sharing amount.
- Call the provider and your plan together if you can, and say the words: this appears to be a balance bill barred by the No Surprises Act.
- If it goes nowhere, the federal No Surprises Help Desk at 1-800-985-3059 takes these cases directly.