ACA and Surprise Medical Bills: What You Need to Know

ACA and Surprise Medical Bills: What You Need to Know


The Affordable Care Act (ACA) was enacted in 2010 to expand access to affordable health insurance for millions of Americans. One important provision of the ACA is protection against surprise medical bills.

Understanding ER Coverage Under the ACA

The ACA requires health insurance plans to cover emergency room visits, regardless of whether the ER is in-network or out-of-network. In an emergency situation, you should seek care at the nearest hospital without worrying about the cost.

Balance Billing

Balance billing occurs when a hospital or provider charges a patient the difference between the amount billed and the amount paid by the insurance company. This can happen even if the ER visit is covered under the patient’s health plan.

What to Do If You Receive a Surprise Bill

If you receive a surprise medical bill, you have several options:

Contact your insurance company: Explain the situation and ask them to help you resolve the issue.
Negotiate with the hospital: You can try negotiating a lower payment plan with the hospital.
File an appeal: You can file an appeal with your insurance company or the state insurance department.

Emergency Room Coding

It’s important to note that the way an ER visit is coded can impact the amount you owe. If the visit is coded as non-emergency, your insurance company may refuse to cover the cost.

ACA Marketplace Plans

If you have health insurance through the ACA Marketplace, you have additional protections against balance billing. Your plan cannot charge you more than the in-network cost-sharing for emergency room visits.


Surprise medical bills can be a financial burden for patients. The ACA provides important protections against this practice. If you receive a surprise bill, don’t hesitate to contact your insurance company or the state insurance department for assistance. By understanding your rights under the ACA, you can protect yourself from unexpected medical expenses.

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