In December of 2020, Congress passed the No Surprises Act (NSA), which protects patients from unexpected out-of-network (OON) “surprise” medical bills (legislative text can be found in Title I of Division BB of the Consolidated Appropriations Act of 2021). The NSA also creates a process for resolving reimbursement disputes between the OON provider and the patient’s health plan in these scenarios.

The purpose of the NSA is to protect commercially insured patients from high OON bills when they receive OON care at an in-network facility. In these scenarios, patients had reason to believe the care was in-network and had no advanced knowledge or control over the OON care. For example, a patient receiving surgery at an in-network hospital might unknowingly receive care from an OON anesthesiologist. OON emergency care also falls into this category because emergency services, by definition, cannot be scheduled in advance and require immediate attention.

Prior to the NSA, the OON provider could “balance bill” the patient for any amount not covered by the patient’s health plan. Some states passed laws protecting patients in these scenarios. However, not every state had such laws, and those that did lacked jurisdiction over federally regulated health plans. The NSA is intended to fill in gaps where state laws either do not exist or lack jurisdiction.

In addition to these patient protections, the NSA also requires all healthcare providers to furnish a good faith estimate of the cost of care to patients and comply with various information disclosure requirements. 

CAI developed a detailed guide to understanding the NSA’s provisions.