Surprised? You may not need to pay.
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Medical bills can be confusing, especially if you sought care for an unexpected condition or injury. You could find yourself wary of opening bills and explanations of benefits (EOBs) that roll in afterward, especially if youâre discovering the care was considered out-of-network or otherwise uncovered by your health insurance plan and leaving you to foot a big bill.
The No Surprises Act (NSA) of 2022 aims to help you deal with unexpected medical bills, whether you received emergency care or had a procedure at an in-network facility but received a bill from an out-of-network provider. It helps you avoid paying erroneous bills, prevents outstanding amounts from going to collections, and helps save your credit rating.
Key Points
- The No Surprises Act took effect in 2022 to help eliminate unexpected expenses for out-of-network emergency services or providers.
- The law limits the amount charged to consumersâ in-network costs and prohibits certain providers from âbalance billing.â
- If youâre uninsured or paying for care without using insurance, you can dispute a bill thatâs at least $400 more than the providerâs good faith estimate.
What is a surprise medical bill?
A surprise medical bill is an unexpected notice requesting money that shows up after a medical procedure. Perhaps you were involved in a car crash and had no choice but to get care at an out-of-network hospital. You didnât have time to shop around for doctors or get an estimate for the cost of surgeryâyou just needed care, fast.
No Surprises Act: What changed in 2026?
In August 2026, federal regulators updated the dispute-resolution process insurance companies and healthcare providers use to settle covered out-of-network bills. The changes do not alter the lawâs basic consumer protections against surprise medical bills.
Or maybe you planned surgery at an in-network facility and even got a presurgery estimate from your doctor. But the anesthesiologist used was considered an out-of-network provider and sent a separate bill that your health insurance doesnât appear to cover.
In either case, you could find yourself staring down at a hefty balance that you neither expected nor budgeted for.
What is the No Surprises Act?
The No Surprises Act is a federal law enacted in 2020, with its primary consumer protections taking effect in January 2022, that protects consumers from surprise medical billing after planned or emergency care. It builds on existing protections for consumers with government health plans like Medicare, Medicaid, Tricare, and more.
An estimated 16% of hospital admissions each year involve at least one out-of-network claim.
No surprises: Emergency care
If you experience a medical emergency and visit an out-of-network provider, youâre protected from surprise billsâno prior authorization required. Even if the hospital, doctors, or laboratory are considered out-of-network for your plan, the No Surprises Act protects you from getting stuck paying the difference between what your plan paid and the total amount youâre billed.
What if you get a balance bill in the mail for emergency care that should fall under the act? Your first step is to reach out to the provider and your insurance carrier. Itâs their responsibility to negotiate with each other and determine the total payment due.
Is that bill for real?
Before paying a medical bill, be sure itâs legitimate. Whether the request is made by mail, phone, text, or email, protect yourself from potential identity theft.
No surprises: In-network facility care
Even if you planned a procedure at an in-network facility, you might receive multiple bills from each care provider (plus the facility itself) and discover that even though the facility is in-network, not all of your care providers were.
If you took the time to find an in-network facility, schedule a covered procedure, and get an estimate, receiving an out-of-network bill can come as a surprise.
These bills are often related to auxiliary treatment or care providers who probably didnât supply an estimate before your procedure. They may include:
- Anesthesiology
- Surgical or physician assistants
- Lab testing
- Radiology
- Pathology
- Drug abuse or mental health interventions
When out-of-network providers bill for amounts beyond what insurers pay, itâs known as âbalance billing.â This is prohibited for services such as radiology and anesthesiology under the NSA.
What if a medical bill goes to collections?
Itâs best to catch any bills before they go to collections if you can. That way you donât have to deal with disputing reports on your credit history. There are some steps you can take:
- Contact the medical providerâs office to ensure the bill was processed through your insurance plan.
- Compare the bill you received with your explanation of benefits.
- Compare your bill to any good faith estimate you received before your procedure. (If your final bill is more than $400 over this estimate, you can dispute it.)
- Contact your insurance company to provide any additional information it might need.
In many cases, these steps are enough to correct the issue or at least stop it from going to collections and potentially damaging your credit score. But even if the bills still wind up in collections, donât worry. You can submit a dispute with the credit bureaus and get those balances removed from your credit report after the problems are resolved.
No one enjoys dealing with medical bills, insurance companies, or unexpected charges, let alone all three at once. But the No Surprises Act can help protect you from surprise medical bills that you didnât expect or couldnât shop around for.
Although you canât predict when youâll need emergency medical care, these safeguardsâplus good faith estimates and EOBsâhelp ensure that you understand your medical costs, what you are responsible for paying, and the rights you have as a consumer.
This article was most recently revised and updated by Stephanie ColestockThis article was most recently revised and updated by David Schepp
