What is the No Surprises Act, and what disputes does it create?

The federal No Surprises Act, enacted as part of the Consolidated Appropriations Act of 2021, protects patients from many surprise out-of-network medical bills — for example, for emergency services, for care from out-of-network providers at in-network facilities, and for air ambulance services. It limits what the patient pays to their normal in-network cost-sharing and shifts the payment dispute to the provider and the health plan. That shift is what generates a large volume of provider-versus-payer disputes over how much the plan must actually pay the out-of-network provider — disputes the patient is no longer part of, but that the provider and insurer must resolve between themselves.