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No Surprises: People Against Unfair Medical Bills

Surprise medical bills are particularly egregious because they are unpredictable for families and occur despite every effort people make to avoid them. They are the result of a systemic problem that places families in the middle of a tug-of-war between health care providers and insurers over the price of care.

We are organizations that represent consumers, patients, and workers. We called on Congress to enact legislation to protect people by banning surprise medical billing and ensuring that health care costs don’t inflate, and in December 2020 the No Surprise Act was passed into law.

Surprise Medical Bills Are Common

1 in 5

emergency department visits result in a surprise medical bill.

Nearly 70%

of air ambulance patient transports are out-of-network

The No Surprises Act: 3 Key Principles

Principle 1: Ban Surprise Balance Billing and Fully Protect Consumers

  • Balance billing should be completely prohibited in any care situation where consumers cannot ensure they will see an in-network provider or visit an in-network facility, including in emergencies, at in-network facilities, and for air and ground emergency transit.

  • For out-of-network care that individuals incur due to no fault of their own, they should pay no more than in-network cost-sharing (including copayments, co-insurance, and deductibles).

  • Out-of-pocket spending should count towards a consumer’s in-network out-of-pocket maximum and deductible.

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Principle Two: Contain Total Costs for Consumers

  • To ensure that insurance premiums or overall health care costs aren’t unfairly increased, a reasonable payment level between insurers and out-of-network providers for surprise bill situations must be established.

  • A reasonable payment level should be based on actual prices being paid in the market, and not be inflationary (e.g., should not be based on billed charges, which almost always do not accurately reflect price).

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Principle Three: Ensure Comprehensive Protection Nationwide

  • Federal law should apply to surprise bill situations unless state law is equally or more robust in terms of consumer protections. Federal law should determine the payment level owed by a plan to a provider in a surprise bill situation except when a state law already established a payment level prior to passage of federal law. If the federal law covers surprise bill situations not covered by an established state law, the federal law should wrap around the state law to set the payment rate in
    those situations.


  • Even if states have robust surprise billing laws, federal law should apply to any situations that states cannot fully regulate, such as self-insured, ERISA-regulated plans and air ambulance bills.

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Organizations That Have Participated In the No Surprises Campaign

  • Families USA Action


  • AFR, Americans for Financial Reform

  • American Kidney Fund

  • AMSA, American Medical Student Association

  • Community Catalyst

  • Consumer Reports

  • Doctors for America

  • Health Care for America Now!

  • Indivisible

  • NAMI, National Alliance on Mental Illness

  • NCL, National Consumers League

  • National Partnership for Women & Families

  • Public Citizen

  • U.S. PIRG, U.S. Public Interest Research Group

  • Voices for Progress

  • YI, Young Invincibles

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