No Surprises Act Consumer Advocate Toolkit
Learn to identify when consumers have protections under the No Surprises Act and find out how to help them resolve related medical billing issues.
No Surprises Act Toolkit for Consumer Advocates
How to use this Toolkit
Select the options below to learn more about the No Surprises Act Consumer Advocate Toolkit.
- A quick introduction
The No Surprises Act was signed into law on December 27, 2020. This law gives consumers new federal protections from surprise medical bills by prohibiting balance billing and limiting consumer cost sharing in certain circumstances where surprise billing has been common.
In general, the No Surprises Act protects consumers covered under group health plans and group and individual health insurance coverage. This includes consumers with a plan or coverage obtained through an employer, the Federal Employees Health Benefits Program, the Health Insurance Marketplace®, or an individual plan purchased directly from an insurance company.* The new surprise billing protections apply when these consumers receive:
- Most emergency services from out-of-network providers or out-of-network emergency facilities;
- Non-emergency services from out-of-network providers with respect to a patient’s visit to certain types of in-network health care facilities; and
- Air ambulance services from out-of-network air ambulance service providers.
If consumers are uninsured or decide not to use their health insurance for a service, the new law enables them to get a good faith estimate of the expected cost of their care up front, before receiving the service. If consumers receive a bill significantly higher than the estimate, they may be able to dispute the charges through a new federal arbitration process.
The No Surprises Act also includes other new protections related to continuity of care, provider directories, health plan insurance cards, and more. Most No Surprises Act provisions went into effect on January 1, 2022, although some have not yet been implemented. See No Surprises Act Protections: Status of Implementation (PDF).**
*For a more complete list of the types of health coverage subject to the No Surprises Act, see No Surprises Act: Overview of Key Consumer Protections (PDF). As noted above, the No Surprises Act protections generally apply to individuals who are covered by group health plans and group or individual health insurance coverage (including grandfathered health plans), and Federal Employees Health Benefits (FEHB) Program carriers. Throughout this toolkit, unless otherwise specified, terms such as “health insurance,” “health plan,” and “health coverage” are used interchangeably to refer to these coverage types. The term “health insurance issuer” (or “issuer”) refers to an insurance company (including FEHB carriers) that offers group or individual health insurance coverage.
**This Consumer Advocate Toolkit provides information on many of the new consumer protections included in the No Surprises Act. Information on additional provisions of the law will be provided in the future.
- Who is this toolkit for?
This toolkit is designed for consumer advocates and others who help individuals resolve medical billing problems. It was created to support advocacy organizations that provide a range of services, including groups that:
- Educate the public about how to tackle medical debt;
- Operate help lines that screen consumer complaints and make referrals to government agencies; and
- Help consumers directly with their billing issues, such as legal assistance organizations.
- How can advocates use this toolkit?
Consumer advocates can use this toolkit when working directly with consumers who may be faced with surprise medical bills. The toolkit can help advocates identify whether a consumer may have protections under the No Surprises Act. It can also help them to:
- Understand the provisions of the No Surprises Act;
- Understand the interaction between federal and state surprise billing laws;
- Recognize new documents that consumers may receive from providers and health plans;
- Find additional assistance and help consumers file a surprise billing complaint; and
- Create and share informational materials with the public about the No Surprises Act’s new protections.
- What does the toolkit contain?
The toolkit provides the following information:
- Background information providing context about the U.S. health coverage system;
- Introductory information about who is covered by No Surprises Act protections;
- Fact sheets describing the No Surprises Act protections and status of implementation;
- Information about how the No Surprises Act interacts with state surprise billing laws;
- Sample documents that consumers may see as a result of the new law;
- Decision trees to help consumer advocates analyze a consumer’s situation and determine whether they may have protections under the No Surprises Act;
- Fact sheets describing actions that can be taken to resolve instances of non-compliance with the federal law and how to work with the No Surprises Help Desk; and
- Reference materials, including legal citations and a glossary of key terms.
NOTE: These resources contain links to non-United States Government websites. We are providing these links because they contain additional information relevant to the topic(s) discussed in this document or that otherwise may be useful to the reader. We cannot attest to the accuracy of information provided on the cited third-party websites or any other linked third-party site. We are providing these links for reference only; linking to a non-United States Government website does not constitute an endorsement by CMS, HHS, or any of their employees of the sponsors or the information and/or any products presented on the website. Also, please be aware that the privacy protections generally provided by United States Government websites do not apply to third-party sites.