No Surprises Act

Your Rights and Protections Against Surprise Medical Bills

When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible.

What is “balance billing” (sometimes called “surprise billing”)?

When you see a doctor or other healthcare provider or receive laboratory services, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. You may have other costs or have to pay the entire bill if you see a provider, visit a healthcare facility, or receive laboratory services from a laboratory that isn’t in your health plan’s network.

“Out-of-network” means providers (including laboratories) and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be allowed to bill you for the difference between what your plan pays, and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your plan’s deductible or annual out-of-pocket limit.

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider. Surprise medical bills could cost thousands of dollars depending on the procedure or service.

Insurers are required to tell you which providers, hospitals, and facilities are in their networks. Hospitals, surgical facilities, and providers must tell you which provider networks they participate in on their website or on request.

You are protected from balance billing for:

Emergency services

If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most they can bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

In addition to the protections of the Federal No Surprises Act, the state in which you receive services may have protections that apply to your visit for emergency or non-emergency services. Additional information is available from your state government. (See Appendix A below for more information).

 Certain services at an in-network hospital or ambulatory surgical center

When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers can bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed. If you receive other types of services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.

 You’re never required to give up your protections from balance billing. You also aren’t required to get out-of-network care. You can choose a provider or facility in your plan’s network.

 In addition to the protections of the Federal No Surprises Act, the state in which you receive services may have protections that apply to non-emergency services at an in-network facility. Additional information is available on your state’s website (See Appendix A below for more information).

When balance billing isn’t allowed, you also have the following protections:

 You’re only responsible for paying your share of the cost (e.g., copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.

Generally, your health plan must:

  • Cover emergency services without requiring you to get approval for services in advance (also known as “prior authorization”).
  • Cover emergency services by out-of-network
  • Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of
  • Count any amount you pay for emergency services or out-of-network services toward your in- network deductible and out-of-pocket

If you think you’ve been wrongly billed, contact your state (See Appendix A below for your state’s contact information) or the Centers for Medicare and Medicaid Services at 1-800-985-3059. Your state website can be found at www.[enter your state name].gov and by searching “no surprises, balance billing or consumer protections.” Visit for more information about your rights under federal law.


 Under the law, healthcare providers need to give patients who don’t have certain types of health coverage or who are not using certain types of health care coverage an estimate of their bill for health care items or services before those items and services are provided.

  • You have the right to receive a Good Faith Estimate (GFE) for the total expected cost of any healthcare items or services upon request or when scheduling such items or services. This includes related costs like medical tests, prescriptive drugs, equipment, and hospital fees.
  • If you schedule a healthcare item or service at least three (3) business days in advance, make sure your healthcare provider or facility gives you a GFE in writing within one (1) business day after scheduling.
  • If you schedule a healthcare item or service at least ten (10) business days in advance, make sure your healthcare provider or facility gives you a GFE in writing within three (3) business days after scheduling.
  • You can also ask any healthcare provider or facility for a GFE before you schedule an item or service. If you do, make sure the healthcare provider or facility gives you a GFE in writing within three (3) business days after you ask.
  • If you receive a bill that is at least $400 more for any provider or facility than your GFE from that provider or facility, you can dispute the bill.
  • Make sure to save a copy or picture of your GFE.

For questions or more information about your right to a Good Faith Estimate, visit:, email, or call 1-800-985-3059.

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Appendix A: State Contacts & Consumer Protection Information

State To File a Complaint Department of Insurance State Balance Billing Website
AK Alaska Division of Insurance

1-907-269-7900 or email at
AL Alabama Department of Insurance at 1-334-269-3550
AR Arkansas Insurance Department Consumer Services Division at 1-800-852-5494


AZ Arizona Department of Insurance and Financial Institutions at 1- 602-364-3100
CA Department of Insurance Help Center at 1-800-927-4357 or
CO Consumer Services Division 1-303-894-7490 or 1-800-930-3745 email
CT Consumer Helpline: 1-800-203-3447 or 1-860-297-3900

Email to
DE File a Complaint/Appeal – Delaware Department of Insurance – State of Delaware Consumer Services Division

1-800-282-8611 or 1-302-674-7310 email at:
FL Consumer Helpline

1-877-MY-FL-CFO (1-877-693-5236) or 1-850-413-3098 or email:


GA Georgia Office of Commissioner of Insurance and Fire Safety 1-404-656-2070 or 1-800-656-2298 or email:
HI Contact 1-808-586-2790 or email to or None
IA Iowa Insurance Division



ID Idaho Consumer Affairs

1-208-334-4319 or 1-800-721-3272
IL Illinois Department of Insurance


IN Indiana Department of Insurance, call 1-800-457-8283 or text 1-855-463-5292 or email:
KS Kansas Department of Insurance Consumer Division at 1-800-432-2484 or 1-785-296-7829 (out of state) or Kansas Department of Insurance at or

KY or Kentucky Department of Insurance

1-502-564-3630 or toll free at 1-800-595-6053.


LA Louisiana Department of Insurance at 1-800-259-5300 N/A
MA Massachusetts Division of Insurance Consumer Service Unit at 1-617-521-7794 or mail to 1000 Washington Street, Suite 810, Boston, MA  02118
MD Maryland Insurance Administration

Life and Health Complaints Unit

200 St. Paul Place, Ste 2700

Baltimore, MD  21202

P: 1-410-468-2000 or

Toll Free: 1-800-492-6116



Health Education and Advocacy Unit

Office of the Attorney General

200 St. Paul Place, 16th Floor

Baltimore, Maryland 21202

P: 1- 410-528-1840 or

Toll Free 1-877-261-8807

En Español: 1- 410-230-1712

Fax: 1- 410-576-6571
ME State of Maine Professional & Financial Regulation

35 State House Station

Augusta, ME  04333

T: 1-207-624-8500

F: 1-207-624-8690

MI Michigan department of Insurance and Financial Services

1-517-284-8800 or

Toll free at 1-877-999-6442

Michigan Department of Insurance and Financial Services
MN Minnesota Department of Health at or

Minnesota Department of Commerce at

Minnesota Department of Commerce

MS Mississippi AG Office – Consumer Protection Division

1-601-353-0845 or


Mississippi Insurance Department

MT Commissioner of Securities and Insurance Office of the Montana State Auditor at 1-406-444-2040 or

NC North Carolina Department of Insurance

325 N. Salisbury Street

Raleigh, NC 27603

ND North Dakota Insurance Department or

NE Nebraska Department of Insurance

Attn: Life & Health Division

P.O. Box 95087

Lincoln, NE  68509-5087
NH New Hampshire Department of Insurance or

NJ NJ Department of Banking & Insurance

PO Box 471

Trenton, NJ  08625-0471

1-609-292-7272 or 1-800-446-7467
NM Office of Superintendent of Insurance

PO Box 1689

Santa Fe, NM  87504-1689

NV Nevada Department of Insurance

NY NY Department of Financial Services

1-800-342-3736 or
OH Ohio Department of Insurance or 1-800-686-1526

Ohio Department of Insurance at:
OK Oklahoma Insurance Department

OR Oregon Division of Financial Regulation

1-888-877-4894 or
PN Pennsylvania Insurance Department

1-877-881-6388 or

TTY/TDD at 1-717-783-3898
RI Rhode Island Insurance Division

1-401-462-9520 or


SC South Carolina Department of Insurance

Office of Consumer Services

SD South Dakota Division of Insurance

124 South Euclid Ave., 2nd Floor

Pierre, SD 57501

TN Tennessee Department of Commerce & Insurance

1-615-741-2218 or 1-800-342-4029
TX Texas Department of Insurance

UT Utah Insurance Department

Health & Life Division


Toll Free: 1-800-439-3805 (in state)
VA Virginia State Corporate Commission Bureau of Insurance


Consumers covered under (i) a fully-insured policy issued in Virginia, (ii) the Virginia state employee health benefit plan; or (iii) a self-funded group that opted-in to the Virginia protections are also protected from balance billing under Virginia law.

VT Vermont Department of Financial Regulation

1-802-828-3302 or 1-800-964-1784
WA Washington State Office of the Insurance Commissioner

1-800-562-6900 or
WADC District of Columbia Department of Insurance, Securities & Banking

1-202-727-8000 or

WI Wisconsin Office of the Commissioner of Insurance

1-608-266-3585 or 1-800-236-8517
WV WV Offices of the Insurance Commissioner

1-304-558-3386 1-888-879-9842
WY Wyoming Department of Insurance

Consumer Affairs

307-777-7402 or 1-800-438-5768