Your Rights Under the No Surprises Act

Cost is never a reason to delay emergency care. If it might be an emergency, call 911 or come in. Ability to pay is not a barrier to being assessed in our emergency rooms. Sort the bill out afterwards — that is what the rest of this page is for.

There is a federal law about exactly the thing people are afraid of, and most people have never heard of it.

The Centers for Medicare & Medicaid Services, on what it does:

“The No Surprises Act… protects you from unexpected out-of-network medical bills from: Emergency room visits”

Emergency room visits are first on their list. It took effect on 1 January 2022 and applies to most health insurance types.

What it actually does

Two things, and the second is the one that surprises people.

Your plan has to treat an out-of-network emergency room as in-network for what you pay. Your share is calculated at in-network rates, and it counts toward your in-network deductible and out-of-pocket maximum rather than a separate, higher, out-of-network one.

And the facility cannot bill you for the difference. That practice — charging a patient the gap between what an insurer paid and what the provider charged — is balance billing, and for emergency services it is prohibited.

That combination is the protection. It means the network status of the emergency room you walked into is not supposed to decide what you owe.

What it does not do, and this matters

It does not make the visit free. This is the sentence that gets left out of every cheerful summary, so here it is plainly:

In-network cost-sharing is not “no cost-sharing.” Your deductible still applies. Your coinsurance still applies. If you have a high-deductible plan, an emergency visit can still be a large bill — **it is just not a surprise bill, and it is not inflated for being out of network.**

Anybody telling you an emergency room visit will not cost you more than usual is overstating a real protection, and we would rather you heard the accurate version from us than the reassuring version from anyone.

“Most health insurance types” is also not “all.” CMS says most. If your coverage is unusual — certain short-term or limited-benefit arrangements — the protections may not reach you, and that is worth confirming with your plan rather than assuming.

If you have no insurance, or you are not using it

A different right applies, and it is a good one. CMS:

“Usually, if you don’t have or use health insurance, providers must give you a good faith estimate of what your care will cost.”

You get it when you schedule care in advance, or if you ask for one. So asking is a thing you are entitled to do, and most people do not know that.

And it has teeth. If the final bill exceeds the estimate by $400 or more, you can dispute it.

Say at the desk that you are self-pay. It is a normal conversation, it is not an obstacle to being seen, and it starts the estimate process.

The ambulance gap, said out loud

CMS’s list names air ambulance services as covered. It does not name ground ambulance.

So if you arrived by ground ambulance, treat that bill as a separate question and ask about it specifically — it is a different bill, from a different organisation, and it may sit outside these protections. Nobody tells patients this and it is where a genuine surprise still happens.

If a bill looks wrong

CMS runs a help line for exactly this, and it is free:

1-800-985-3059 — seven days a week, with help available in Spanish, French, Arabic, Russian, Nepali “and 350 other languages.”

You can also complain. CMS: “You can submit a complaint if you believe that your facility, provider, or insurer isn’t following these rules.” That includes us. If you think we have billed you in a way these rules forbid, that route exists and we would rather you used it than paid something you did not owe.

And call the facility you were seen at first, because most billing questions turn out to be a coding or an insurance-processing question rather than a rights question, and the people holding your record can answer faster than anybody.

Where this leaves you

Come in if you need to. The protections above exist so that the network status of an emergency room is not a thing you have to research at two in the morning with chest pain.

Our emergency rooms are open every hour of every day and are walk-in. Go to the nearest one, and if another emergency department is closer to you, that one is the right answer tonight — and these protections travel with you, because they are federal law rather than our policy.

If you are unsure whether it is an emergency, come in. That decision should never be made on cost, and which door you need is the honest version of the question.

Questions people actually ask

Is your emergency room in my network? Ask the facility about your specific plan and you will get an accurate answer. For an emergency visit, the protections above apply either way — that is the point of them.

So an emergency room visit will not cost me anything? No, and we are not going to tell you that. Your deductible and coinsurance still apply. What the law prevents is the surprise — an inflated out-of-network share, and a bill for the gap.

Does this cover my clinic appointment too? No, and that is an important difference — these emergency protections are about emergency care. A routine clinic visit is a different situation with different rules, and the two regimes are genuinely different.

I already paid a bill I think was wrong. Call the facility, and call 1-800-985-3059. Having paid does not forfeit anything.

What about the doctor’s bill as well as the facility’s? You may receive more than one bill for one visit, which is normal and confusing in equal measure. The protections cover the emergency services; if a bill arrives that looks like a balance bill, that is exactly what the help line is for.

I have no insurance and I cannot pay. Come in anyway if it might be an emergency. Say you are self-pay, ask for the good faith estimate, and have the conversation about payment afterwards. Being assessed is not conditional on it.

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Cost is never a reason to delay emergency care. If a bill looks wrong, call the facility and then 1-800-985-3059. Both of our emergency rooms are open 24 hours a day, every day of the year — walk in, no appointment and no referral. Find your nearest emergency room →

Related reading: in-network and out-of-network for emergency care · which door do you need

Sources

7. Medical Bill Rights — Centers for Medicare & Medicaid Services. https://www.cms.gov/medical-bill-rights

This article is general information about federal protections, not advice about your specific plan or your specific bill. It publishes no cost figures. If it might be an emergency, treat it as one and call 911.