No Surprises Act: What Providers Should Know About the New Patient Protection Legislation

By: Cristina N. Hyde, JD

On December 27, 2020, H.R. 133 (116th), better known as the Consolidated Appropriations Act, 2021, was signed into law.  Included therein, was a key consumer protection law designed to shield patients from receiving unexpected, and often exorbitant, out-of-network medical bills.  Effective as of January 1, 2022, the No Surprises Act (the “NSA”) provides patients with federal protections against balance billing; specifically requiring private health insurance companies to cover certain out-of-network bills and prohibiting providers from billing patients more than they would have to pay for in-network care.


Key provisions of the NSA include:

  • The requirement that insurers who cover emergency services bill plan holders no more than the median in-network rate for a particular service, even if the provider is out-of-network; ensuring that most emergency care is covered as if it were in-network without any requirement for prior authorization.
  • A restriction on balance billing for non-emergency services to only those circumstances where the out-of-network provider has complied with specific notice and consent requirements and was not the only provider available to deliver care at the particular in-network facility.
  • A requirement that facilities and providers give patients notices explaining, and publicly post, applicable billing protections and grievance procedures.
  • A requirement that uninsured patients receive important information that includes a good-faith estimate of costs before being provided non-emergency care.

While the new legislation may provide much-needed security for patents seeking emergency care, providers should know that failure to abide by the NSA can result in some hefty penalties.  As a result, providers should make it a priority to review and revise their billing practices and post all notices relevant to surprise billing.

Additional information, including detailed balance billing rules and standard notice and consent forms, can be found on the United States Centers for Medicare & Medicaid website.

Our Principal Attorney will be hosting a free webinar on this topic on Wednesday, January 19, 2022 at 12:30PM.   Register for the webinar here!

If you have questions about the No Surprises Act and how it affects you or your health care facility, Contact Us.

Comments are closed.