No Surprises Act Notice and Disclosures

Rights and Protections Against Surprise Medical Bills for Emergency Services and Certain Services from Out-of-Network Providers at an In-Network Hospital or Ambulatory Surgical Center

Plan participants are protected from surprise billing, also called balance billing, for emergency care and claims from out-of-network providers that rendered certain services at an in-network hospital or in-network ambulatory surgical center.

Emergency services

The most a provider or facility may bill a participant is the plan’s in-network cost-sharing amount (such as co-payments and co-insurance). The provider cannot balance the bill for emergency services. This includes services after a patient has been stabilized, unless the patient provides written consent and gives up protections from being balance billed for post-stabilization services.

Certain services from out-of-network providers at an in-network hospital or ambulatory surgical center

Out-of-network providers at an in-network hospital or in-network surgery center that provide emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeons, hospitalists, or intensivists services, are not permitted to balance bill. They are not permitted to ask a patient to consent to give up protections against balance billing.

Out-of-network providers of other services at in-network facilities may only balance bill a participant if the participant gives written consent and gives up the protections from balance billing.


For information and complaints related to balance billing, contact the U.S. Department of Health & Human Services at 1-800-985-3059 or visit for more information about the No Surprises Act, payment disputes and patient rights under federal law.

Visit for more information about your rights under federal law.

More about the No Surprises Act

No Surprises Act introduces a new term called the Qualifying Payment Amount, or QPA, and defines it as the plan’s median contracted rate — the middle amount in an ascending or descending list of contracted rates. The most a provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). The law requires providers to accept the QPA as payment in full for out-of-network emergency services. In addition, certain services provided by out-of-network providers at in-network facilities are also subject to these protections unless the patient provides consent to be billed.