In 2022, the No Surprises Act went into effect. Being a law, it mandates certain protections to defend patients from balance billing. It applies to emergency services at out-of-network hospitals, out-of-network providers at in-network facilities, and out-of-network air ambulance carriers.

How is the No Surprises Act used?

The No Surprises Act includes a provision that every patient receives an Advanced Explanation of Benefits (AEoB), which lets patients know the expected cost of care in advance of the procedure, but as of 2025, it is not implemented. It also requires a Good Faith Estimate (GFE), which is not a bill,  to be delivered to uninsured and self-pay patients three days before care, and if the bill exceeds the GFE by more than $400, this provides ample cause for dispute.

FAQ

Does the No Surprises Act apply out-of-network?

The No Surprises Act does not apply out-of-network if a member voluntarily chooses to use out-of-network providers. However, it does apply out-of-network at in-network facilities and for emergency services.

Does the No Surprises Act prohibit balance billing altogether?

In many cases, the No Surprises Act does prohibit balance billing, but not in every case. Generally, out-of-network providers are only allowed to balance bill patients if the service is not ancillary (not emergency medicine),  the provider gives advance notice that the service is out-of-network and provides an estimated cost, and the member acknowledges they received the notice.

What’s the difference between an AEoB and a GFE?

Insurance delivers the AEoB, while the hospital delivers the GFE. Because of that, the AEoB focuses mainly on expected out-of-pocket cost, while the GFE estimates the overall charge.

Conclusion

We hope this article answered all your No Surprises Act questions! At Fairdoc, we are here to inform you, assist you, and answer all your questions. If you have any inquiries for us, feel free to reach out, and stay tuned for future articles!