The No Surprises Act 42 U.S.C. § 300gg-111 prohibits hospitals and providers from charging you more than your in-network cost-sharing for emergency care or for out-of-network providers at in-network facilities who treated you without your advance written consent. When providers violate this law, they can face civil monetary penalties of up to $100 per day per violation. Here's how to report it.
The Act applies when:
The Act does NOT apply to: ground ambulances, out-of-network facilities you voluntarily chose for non-emergency care, or providers for whom you signed a valid out-of-network consent form for a genuinely voluntary service.
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Check my bill free →CMS routes your complaint to the appropriate enforcement body — either the federal government or your state's insurance department, depending on your plan type. The provider receives notice of the complaint and is given an opportunity to respond. CMS or the state regulator investigates and determines whether a violation occurred.
Providers found to have violated the No Surprises Act face civil monetary penalties of up to $100 per day per violation, corrective action requirements, and potential exclusion from Medicare and Medicaid for repeat violations. These are significant consequences that motivate providers to resolve complaints quickly.
You also have the right to external review. If your insurer applied out-of-network cost-sharing when you believe you should have been charged in-network rates, you can request external review — an independent review by a third party that is binding on your insurer. Ask your insurer for external review procedures or contact CMS for assistance.
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Check my bill free →It depends. For emergency care, you cannot waive your No Surprises Act protections — any consent form for out-of-network billing during an emergency is invalid. For non-emergency care, if you signed a valid consent form acknowledging out-of-network status for a genuinely voluntary service (where you had a real choice of providers), the Act may not apply. However, for ancillary providers like anesthesiologists, radiologists, and pathologists, valid consent forms cannot be obtained at all — these providers are always covered by the Act at in-network facilities.
CMS aims to resolve No Surprises Act complaints within 30 days for straightforward cases. Complex cases may take longer. Filing simultaneously with your state insurance commissioner can accelerate resolution.
Yes. If CMS or a state regulator determines that a balance bill violated the No Surprises Act, you're entitled to a refund of the excess amount charged. Include the fact that you've already paid in your complaint.