No Surprises Act:
Your Protection Against Unexpected Medical Bills
Starting January 1, 2022, the No Surprises Act protects you from unexpected medical bills when you receive emergency care or are treated by out-of-network providers at in-network facilities. You’re only responsible for your usual in-network costs like copayments, coinsurance, and deductibles—not the full out-of-network charges.
What Is Balance Billing?
Balance billing (also called surprise billing) happens when an out-of-network provider bills you for the difference between what your insurance pays and what they charge. This often leads to higher costs that don’t count toward your out-of-pocket maximum.
Surprise billing can occur when:
- You receive emergency care and can’t choose your provider.
- You’re treated by an out-of-network specialist at an in-network hospital or surgical center.
When You’re Protected
You’re protected from balance billing in these situations:
- Emergency services from out-of-network providers or facilities.
- Certain services at in-network hospitals or surgical centers (e.g., anesthesia, radiology, pathology, neonatology).
Out-of-network providers cannot ask you to waive these protections or bill you more than your in-network cost-sharing amount.
Your Rights
When balance billing is prohibited:
- You only pay your in-network share of costs.
- Your health plan pays the provider directly.
- Emergency services must be covered without prior authorization.
- Payments count toward your deductible and out-of-pocket limit.
If You Think You’ve Been Wrongly Billed
Contact:
- Centers for Medicare & Medicaid Services (CMS): 1-800-MEDICARE or CMS No Surprises Info
- North Carolina Department of Insurance: 855-408-1212
