Surprise Medical Bills Still Hitting Patients Despite No Surprises Act: How to Fight Back in 2025
Despite federal protections that have been in place since 2022, surprise medical bills continue to plague American patients. Recent legislative efforts suggest the No Surprises Act isn't working as intended, with senators introducing new enforcement legislation in July 2025 to strengthen existing protections. Here's what patients need to know about their rights and how to fight unexpected medical charges.
The Ongoing Problem with Surprise Billing
Surprise medical bills occur when patients receive care from out-of-network providers without their knowledge, often during emergencies or at in-network facilities. These unexpected charges can range from hundreds to tens of thousands of dollars, leaving patients caught between their insurance companies and healthcare providers.
The financial impact remains severe. Even with the No Surprises Act protections, patients report receiving bills they believed should be covered by insurance. Air ambulance services remain a particular problem, with more than two-thirds of air ambulance transports historically billed out-of-network, leading to some of the highest medical bills patients face.
What the No Surprises Act Actually Protects
The federal No Surprises Act, which took effect January 1, 2022, provides specific protections for patients with private health insurance:
Emergency Services Protection
- No surprise bills for emergency care, even if you receive treatment out-of-network
- No out-of-network cost-sharing for emergency services
- You pay only your standard in-network deductible, copayment, or coinsurance
Non-Emergency Services at In-Network Facilities
- Protection from out-of-network charges for services like anesthesiology, radiology, or pathology when you visit an in-network hospital
- Balance billing prohibited for these ancillary services
- Patients cannot be charged more than their in-network cost-sharing amount
Air Ambulance Coverage
- In-network cost-sharing only for covered air ambulance services
- Dispute resolution between providers and insurers handles payment disagreements
- Patients are removed from billing disputes
Why Problems Persist: Enforcement Gaps
In July 2025, Senators Michael Bennet and Roger Marshall reintroduced the No Surprises Act Enforcement Act, highlighting ongoing problems with the original legislation. The bill aims to address several enforcement gaps:
- Increased penalties for non-compliant parties who miss statutory payment deadlines
- Enhanced transparency in reporting requirements
- Stronger enforcement of existing patient protections
"The idea that health insurers are breaking the law and unfairly punishing patients and providers is unbelievable," said Senator Marshall, emphasizing that the dispute resolution process isn't working as Congress intended.
When You're Not Protected
Important limitations of the No Surprises Act include:
Ground Ambulance Services
- Not covered by current federal protections
- State laws may provide some protection
- Patients can still receive surprise bills for ground ambulance transport
Non-Emergency Services with Consent
- If you sign a consent form agreeing to out-of-network care
- Schedule flexibility - you can choose in-network providers for planned procedures
- Price estimates must be provided if you consent to out-of-network care
Uninsured Patients
Different protections apply if you're uninsured:
- Good faith estimates required for services scheduled 3+ days in advance
- Dispute process if final bill exceeds estimate by $400 or more
- Right to negotiate payment arrangements
How to Fight Surprise Medical Bills
If you receive an unexpected medical bill, take these steps:
1. Verify the Charges
- Review your insurance explanation of benefits (EOB) carefully
- Confirm the services listed match what you actually received
- Check provider network status at the time of service
2. Know Your Rights
- Emergency services should never result in out-of-network charges
- Ancillary services at in-network facilities are protected
- Balance billing is prohibited in protected scenarios
3. File Appeals and Complaints
- Contact your insurance company to appeal claim denials
- File complaints with CMS No Surprises Help Desk at 1-800-985-3059
- Submit online complaints through official channels
- Contact state consumer assistance programs for additional help
4. Document Everything
- Keep detailed records of all communications
- Save bills, EOBs, and correspondence
- Note dates and names of representatives you speak with
Good Faith Estimates for Uninsured Patients
If you're uninsured or paying out-of-pocket, providers must give you good faith estimates including:
- Expected charges for your visit
- Related costs like tests, medications, and equipment
- Hospital facility fees if applicable
- Written estimates provided at least one day before service (for care scheduled 3+ days ahead)
If your final bill exceeds the estimate by $400 or more, you have the right to dispute the charges through a patient-provider dispute resolution process.
State vs. Federal Protections
The No Surprises Act creates a "floor" of federal protections, but state laws may provide additional safeguards. Some states offer stronger protections, including:
- Ground ambulance protections (varies by state)
- Additional billing timeframes and requirements
- Enhanced dispute resolution processes
Check your state's specific protections, as they may exceed federal minimums.
Looking Ahead: Strengthened Enforcement
The push for enhanced enforcement suggests that 2025 may bring stronger penalties for providers and insurers who violate No Surprises Act requirements. Patients should stay informed about their rights and be prepared to advocate for themselves when unexpected bills arrive.
Remember: if you receive a surprise medical bill for protected services, you shouldn't have to pay it. The burden falls on providers and insurers to resolve payment disputes without involving patients in the billing process.
With proper knowledge of your rights and persistent advocacy, you can successfully challenge inappropriate surprise medical bills and protect yourself from unnecessary financial hardship.