Health Insurance

No Surprises Act

The No Surprises Act limits what patients can be billed when they unknowingly receive care from out-of-network providers in emergency or in-network facility settings.

Last reviewed: May 2026 · Editorial methodology

Definition

The No Surprises Act is a federal law enacted in December 2020 and effective January 1, 2022, that protects insured patients from unexpected medical bills in two key scenarios. First, it limits cost-sharing for emergency services to in-network rates regardless of whether the emergency facility or treating providers are in-network. Second, it restricts out-of-network billing by non-emergency ancillary providers — such as anesthesiologists, radiologists, and pathologists — who perform services at in-network facilities without the patient's prior knowledge and written consent. Under the law, patients receive a good faith cost estimate before scheduled non-emergency services, and disputes between insurers and providers are resolved through an independent dispute resolution (IDR) process rather than by passing costs to the patient. Providers must give patients written notice of their balance billing protections and obtain signed consent before billing out-of-network rates for services covered by the law. The law does not cap costs for scheduled care at out-of-network facilities the patient voluntarily selects.

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Tip

Glossary definitions are educational. Always check your own policy language — insurers can define common terms differently from one another. When in doubt, request a written explanation from your agent.

Related terms

Balance BillingBalance billing can result in unexpected medical bills, particularly when receiving care from out-of-network providers or facilities.Out-of-Network ProviderUsing an out-of-network provider typically triggers higher cost-sharing, a separate deductible, or no coverage depending on your plan type.In-Network ProviderSeeing an in-network provider activates your plan's cost-sharing benefits and typically results in the lowest out-of-pocket costs.Prior AuthorizationPrior authorization is an insurer's cost-control mechanism that can delay care if approval is not obtained in advance.

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Source: Cover Forge USA editorial team|Last verified: May 2026|Methodology
Definitions are educational and may be simplified. Always refer to your policy contract and consult a licensed agent for terms that affect coverage decisions.
CF

Cover Forge USA Editorial Team

Editorial Lead

This article was researched and written by the Cover Forge USA editorial team against federal sources (NAIC, CMS, FEMA, DOL, SSA, state DOIs) and standard policy forms. Bylines organize content by topic — they do not assert individual licensure. See our editorial-policy for details.

Reviewed June 2026

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