No Surprises Act Information

Overview of the No Surprises Act:

The Consolidated Appropriations Act of 2021 was enacted on December 27, 2020, and contains many provisions to help protect consumers from surprise bills, including the No Surprises Act. The No Surprises Act of the Consolidated Appropriations Act (NSA) creates new requirements that apply to health insurance plans/issuers, healthcare providers (including air ambulance providers), and facilities, regarding such topics as cost-sharing rules, prohibitions on balance billing for certain items and services, notice and consent requirements, and requirements related to disclosures about balance billing protections. 

Surprise Billing (Balance Billing):

A surprise bill is an unexpected bill from a health care provider or facility. This can happen when a person with health insurance unknowingly gets medical care from a provider (including air ambulance providers) or a facility outside their health plan's network.

Need a quick answer to a question about the No Surprises Act? Visit our FAQs

  1. Consumer Impact
  2. payer & Provider Impact

Balance Billing:

The No Surprises Act bans balance billing for emergency services and some non-emergency services. As of January 1, 2022, your insurance has to cover emergency services as in-network with no prior authorization. Balance billing isn’t allowed for emergency care, even at out-of-network hospitals, emergency departments, or air ambulance companies.

If you go to an in-network hospital or ambulatory surgical center for non-emergency care, balance billing isn’t allowed for any of these ancillary* services:

  • Anesthesiology, pathology, radiology, or neonatology.
  • Care from assistant surgeons, hospitalists, or intensivists.
  • Diagnostics like radiology or laboratory services.
  • Any other item or service from an out-of-network provider, if an in-network provider wasn’t available.

*Ancillary services are medical services or supplies that are not provided by acute care hospitals, doctors, or health care professionals.

Consent for Out-of-Network Billing:

When you receive emergency care from an out-of-network provider at an in-network facility, they can only send you a balance bill if all of these are true:

  • The provider isn’t on the ancillary services list above.
  • They give you a plain-language explanation of your rights.
  • You give written consent to give up your protections against balance billing.

Choosing to Go Out-of-Network:

If you choose to go out-of-network for specialized care in a non-emergency situation, you waive your right to balance billing protections. 

Disputes Over What You Owe:

  • If you’re paying for services yourself (self-pay or uninsured), you have the right to a good-faith cost estimate from the provider. If a provider bills you $400 or more above that estimate, you can challenge the bill.
  • If you’re using insurance, your insurer can tell you what’s covered and estimate your out-of-pocket costs. If your insurer denies a claim because it says certain services aren’t covered, you can dispute that decision.

Enforcement and Consumer Appeals:

  • The SCDOI has enforcement over issuers (insurance companies and HMOs), while providers and facilities will be under federal enforcement. 
  • Consumers will have the right to appeal health plan denials and decisions that bill the patient for an amount higher than allowable under the provisions of the law. If the plan upholds its decision, an independent external reviewer will make a final determination.
  • If you believe you have received a surprise medical bill from a provider for the services specified above, you have several options to consider. 
    • If your insurance is denying the claim, you can contact the Office of Consumer Services here at the SCDOI. Please call 803-737-6180 to speak with an Insurance Regulatory Analyst.  You can also email your question to or file an online complaint here
    • If your issue is with the provider or healthcare facility, contact the federal government by visiting to file a complaint or by calling 800-985-3059 (toll-free).

Arbitration Between Providers and Insurers:

The No Surprises Act provides insurance companies and health care providers a fair process to resolve [out-of-network] bills without additional cost to patients, meaning, you don’t need to be involved in negotiations or disputes between providers and your insurer. If they disagree over a payment, they need to either work it out themselves or use a new arbitration process.

What isn't Covered by the No Surprises Act:

The No Surprises Act doesn’t ban all surprise and out-of-network bills. Here are two important exceptions: 

  • Ambulances: The act covers air ambulances, but not regular ground ambulances.
  • Facilities: The act applies to care provided in hospitals, emergency departments, and ambulatory surgical centers. Other facilities like clinics and urgent care centers aren’t included but might be added later.

These protections don’t apply to those who are covered by Medicare, Medicaid, TRICARE, Veterans Affairs Health Care or Indian Health Services as these plans already are protected against surprise medical bills.

Report a Surprise Bill:

Contact the federal government by visiting to file a complaint or by calling 800-985-3059 (toll-free).

Or contact the Office of Consumer Services here at the SCDOI by calling 803-737-6180, emailing your question to, or you can file an online complaint here

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