Effective January 2022, the Act prohibits balance billing patients for out-of-network emergency services and for non-emergency services delivered by out-of-network providers at in-network facilities. Patients pay only in-network cost sharing.
Payment disputes between providers and payers are resolved through an independent dispute resolution process rather than litigation.
Alternative Names:
NSA, Surprise Billing Law
Why it Matters?
The Act shifted a large volume of provider-payer conflict from billing litigation into arbitration, and the volume of disputes has substantially exceeded projections. For injury litigation the practical effect is on medical damages, since out-of-network emergency charges that once generated large balance bills are now capped, which affects the billed versus paid analysis in the affected categories.
Frequently Confused with
Related terms
Frequently asked questions
What does the No Surprises Act prohibit?
How are payment disputes resolved?
