When the No Surprises Act took effect on January 1, 2022, it was hailed as a fix for one of the most infuriating aspects of American healthcare: surprise medical bills. The patient who goes to an in-network hospital but gets treated by an out-of-network anesthesiologist. The emergency room visit that generates a bill from a physician group the patient never chose. These scenarios were supposed to end.
Some of them did. Many didn't. And for the procedures where patients need price transparency most — planned, elective care — the Act changed almost nothing.
What the No Surprises Act actually does
The law protects patients from surprise out-of-network billing in two specific scenarios. Emergency services: you can't be balance-billed for emergency care, regardless of whether the facility or providers are in your network. Non-emergency services at in-network facilities: if you go to an in-network hospital and receive care from an out-of-network provider you didn't choose (anesthesiologist, radiologist, pathologist), you can't be billed at out-of-network rates.
These are real protections that help real people. If you've ever received a $5,000 anesthesiology bill after a surgery at your in-network hospital, this law means that won't happen again.
What it doesn't fix
Ground ambulances
The law explicitly excludes ground ambulance services from surprise billing protections. Air ambulances are covered; ground ambulances are not. This is a $1,000–$3,000 surprise bill that the law specifically chose not to address.
Out-of-network facilities you chose
If you voluntarily go to an out-of-network facility — because it's closer, because your doctor practices there, because you didn't know it was out of network until after — the No Surprises Act doesn't help. You can still receive full out-of-network billing.
Total cost transparency
The law doesn't cap total costs. It doesn't require hospitals to publish all-in procedure pricing in a patient-friendly format. It doesn't prevent a knee replacement from costing $45,000. It prevents you from being surprised by a bill from a provider you didn't choose — but the bill from the provider you did choose can still be staggering.
Dental, vision, and elective procedures
The No Surprises Act primarily addresses health insurance plans. Dental and vision insurance operate under different regulatory frameworks. Elective procedures — cosmetic surgery, fertility treatment, LASIK, weight loss surgery — often aren't covered by insurance at all, making surprise billing protections irrelevant. When there's no insurance involved, there's no "surprise" billing — just full-price billing.
The price transparency that was promised
The hospital price transparency rule (separate from the No Surprises Act) requires hospitals to publish standard charges in machine-readable files and provide a patient-friendly price estimator tool. In practice, compliance has been mixed, penalties for non-compliance are weak, and the published data is often so complex that ordinary patients can't use it to compare prices.
The promise of price transparency in American healthcare remains largely unfulfilled. You can find the chargemaster price of a knee replacement at your local hospital, but that number may bear little relationship to what you'll actually pay — which depends on your insurer, your plan, your deductible, the specific providers involved, and whether any of them happen to be out of network.
What actual price transparency looks like
In Colombian medical tourism, you get a quote. It includes the procedure, anesthesia, hospital fees, pre-op labs, post-op medications, and recovery house stay. That's the price. There are no facility fees that appear later. No separate anesthesiology bill. No pathology charges you didn't know about. No "chargemaster" prices that exist to inflate insurance negotiations.
The quote you receive is the quote you pay. This is the price transparency that the No Surprises Act aspired to but didn't deliver.
The transparency comparison
| Dimension | U.S. (Post No Surprises Act) | Colombia Medical Tourism |
|---|---|---|
| Know total price before procedure? | Rarely with confidence | Yes — all-inclusive quote |
| Surprise bills from ancillary providers? | Reduced but not eliminated | Not possible — one package |
| Facility fees separate from procedure? | Yes — common | Included in quote |
| Anesthesia billed separately? | Often | Included in quote |
| Price varies by insurer/plan? | Yes — significantly | One price for self-pay |
What to do
The No Surprises Act helps in the scenarios it covers. For emergency care and surprise out-of-network billing at in-network facilities, it's a meaningful protection. Know your rights and invoke them when needed.
But for planned procedures — especially those poorly covered by insurance — the Act doesn't change your financial reality. The same procedure that costs $45,000 in the U.S. still costs $45,000 in the U.S. The No Surprises Act just means you might know about the $45,000 slightly sooner.
For truly transparent, predictable healthcare pricing, medical tourism remains the clearest path. One quote, all-inclusive, no surprises — literally.