Surprises Billing Protections: At a Glance
Surprise billing is a type of balance billing, which occurs when a provider bills a consumer for the
portion of a bill that the consumer’s health insurance plan or coverage doesn’t cover. A surprise bill is an
unexpected balance bill for certain types of out-of-network costs that aren’t covered. Surprise billing can
often happen when a person does not have the chance to select an in-network provider, such as during a
medical emergency.
The No Surprises Act protects people who are covered under group health plans, group and individual
health insurance coverage, and the Federal Employees Health Benefits (FEHB) program carriers from
surprise medical bills when they receive:
y Most emergency services.
y Non-emergency items and services from out-of-network providers with respect to patient visits to
certain in-network facilities.2
y Services from out-of-network air ambulance service providers.
The No Surprises Act surprise billing protections generally do not apply:
y When non-emergency items or services are provided with respect to a patient visit to an out-ofnetwork facility.
y In certain circumstances when a provider or facility is permitted to provide notice to a consumer (or
their representative) and obtain the individual’s consent to waive the surprise billing protections.
(See When the Notice and Consent Exception Applies and When it Doesn’t: Guidelines for Use.)
y When the items or services provided are not covered by the person’s health plan or insurance.
y To ground ambulance services.
The No Surprises Act Protections Do Not Apply:
To consumers who have coverage through (or receive services provided by) the following government
programs. These programs generally have certain protections against balance billing:
y Medicare (including Medicare Advantage).
y Medicaid (including Medicaid managed care plans).
Surprise billing is a type of balance billing, which occurs when a provider bills a consumer for the
portion of a bill that the consumer’s health insurance plan or coverage doesn’t cover. A surprise bill is an
unexpected balance bill for certain types of out-of-network costs that aren’t covered. Surprise billing can
often happen when a person does not have the chance to select an in-network provider, such as during a
medical emergency.
The No Surprises Act protects people who are covered under group health plans, group and individual
health insurance coverage, and the Federal Employees Health Benefits (FEHB) program carriers from
surprise medical bills when they receive:
y Most emergency services.
y Non-emergency items and services from out-of-network providers with respect to patient visits to
certain in-network facilities.2
y Services from out-of-network air ambulance service providers.
The No Surprises Act surprise billing protections generally do not apply:
y When non-emergency items or services are provided with respect to a patient visit to an out-ofnetwork facility.
y In certain circumstances when a provider or facility is permitted to provide notice to a consumer (or
their representative) and obtain the individual’s consent to waive the surprise billing protections.
(See When the Notice and Consent Exception Applies and When it Doesn’t: Guidelines for Use.)
y When the items or services provided are not covered by the person’s health plan or insurance.
y To ground ambulance services.
The No Surprises Act Protections Do Not Apply:
To consumers who have coverage through (or receive services provided by) the following government
programs. These programs generally have certain protections against balance billing:
y Medicare (including Medicare Advantage).
y Medicaid (including Medicaid managed care plans).
