Colorado’s No Surprises Act protections, layered on top of the federal No Surprises Act, mean you generally cannot be charged more than your in-network cost-sharing for emergency care, for out-of-network providers who treat you at an in-network facility, for air ambulance transport, or for private ground ambulance rides. That last one is a Colorado addition. Everywhere else in the country, ground ambulance sits in a gap the federal law left open.
Which Situations Are Protected
Emergency Care
Every emergency service is covered, whatever hospital, freestanding emergency department, or urgent care center you end up at. An out-of-network provider or facility can bill you no more than your plan’s in-network copayment, coinsurance, and deductible. It doesn’t matter that you had no say in who treated you or that nobody mentioned they were out-of-network.1Cornell Law School. 4 CCR 735-1-A – Your Rights and Protections Against Surprise Medical Bills
Out-of-Network Providers at In-Network Facilities
You pick an in-network hospital or surgery center for a scheduled procedure, but you rarely pick the anesthesiologist, radiologist, pathologist, neonatologist, hospitalist, intensivist, or assistant surgeon. Any of them might be out-of-network. Both Colorado law and the federal No Surprises Act limit those providers to in-network cost-sharing amounts. The same limit applies to lab work and imaging ordered during your visit.1Cornell Law School. 4 CCR 735-1-A – Your Rights and Protections Against Surprise Medical Bills
Air Ambulance
Helicopter and fixed-wing air ambulance transport is covered under the federal law. Your cost-sharing for an emergency flight can’t exceed what you’d pay if the air ambulance provider were in-network.2Centers for Medicare & Medicaid Services. No Surprises Act Overview of Key Consumer Protections
Private Ground Ambulance in Colorado
The federal No Surprises Act does not cover ground ambulance rides, which is why patients in most states can still receive large surprise bills after calling 911.2Centers for Medicare & Medicaid Services. No Surprises Act Overview of Key Consumer Protections Colorado does. The state’s surprise billing rules extend to private ground ambulance providers, so an out-of-network ride is treated the same way as an out-of-network emergency room visit. One boundary: the Colorado protection does not apply to ambulances run by fire departments or other government entities, which bill under separate municipal or county rate structures.3Colorado Division of Insurance. Federal No Surprises Act / Colorado Out-of-Network Billing
Which Health Plans Are Covered
Colorado’s state protections apply to fully insured health plans regulated by the Colorado Division of Insurance. That includes most individual and family plans and plans sold to smaller employers. Self-funded employer plans are governed by federal ERISA rules; they can opt into the Colorado protections, but many don’t. Even when a self-funded plan doesn’t opt in, the federal No Surprises Act still protects you in the core situations above.1Cornell Law School. 4 CCR 735-1-A – Your Rights and Protections Against Surprise Medical Bills
Some coverage sits outside both laws. Medicare, Medicaid, TRICARE, Veterans Affairs health care, and Indian Health Services have their own separate cost protections and are not governed by the No Surprises Act. Short-term health insurance plans, health care sharing ministries, and retiree-only plans are also excluded.4Centers for Medicare & Medicaid Services. The No Surprises Act Continuity of Care, Provider Directories
If you don’t know which category your plan is in, call the number on your insurance card. Your insurer has to tell you whether the plan is state-regulated, self-funded, or exempt.
When a Provider Can Ask You to Waive These Protections
For a narrow slice of non-emergency care, an out-of-network provider at an in-network facility can ask you to give up your surprise billing protections and agree to out-of-network rates. The rules around that waiver are tight, and for many services the waiver isn’t allowed at all.
You cannot waive protections for emergency services. You cannot waive them for the ancillary specialties named above (anesthesiology, radiology, pathology, neonatology, hospitalists, intensivists, assistant surgeons), for situations where no in-network provider is available to perform the service, or for urgent medical needs that come up during your visit.5eCFR. Part 149 Surprise Billing and Transparency Requirements
Where a waiver is allowed, the provider has to hand you a standardized federal notice-and-consent form, separate from other paperwork, that spells out what you’re giving up and estimates what you could owe. Timing depends on when the appointment was booked. If it was scheduled at least 72 hours out, you must get the notice at least 72 hours before the service. If it was scheduled within 72 hours, you must get it the day the appointment is made. For walk-ins, you must get it at least three hours before the service.6Centers for Medicare & Medicaid Services. Standard Notice and Consent Documents Under the No Surprises Act
Your signature has to acknowledge that you know you’re waiving federal protections, that you’re doing it voluntarily, and that what you pay may not count toward your deductible or out-of-pocket maximum. A provider representative has to be available in person or by phone to answer questions. You can cancel in writing any time before the service. Skip any of these steps and the waiver is invalid; your protections stay in place.
If You’re Uninsured or Paying Cash
Without insurance, or when you choose to self-pay, you’re entitled to a written good faith estimate of expected charges before any scheduled service.7Centers for Medicare & Medicaid Services. Overview of Rules and Fact Sheets
If your final bill comes in at least $400 higher than the estimate, you can challenge it through the federal patient-provider dispute resolution process. You have 120 calendar days from receiving the bill to start the process by filing a notice with the Department of Health and Human Services. An independent dispute resolution entity reviews it and sets a fair payment amount.8eCFR. 45 CFR 149.620 – Requirements for the Patient-Provider Dispute Resolution Process
The $400 threshold is measured per provider or facility listed on the estimate, not against the total. If your surgeon’s charges match but the facility fee is $500 over the estimate, you can dispute the facility fee even though the surgeon’s part was accurate.
What You Actually Pay
When a bill is protected, the money fight sits entirely between your insurer and the out-of-network provider. You pay your in-network copayment, coinsurance, or deductible, and that’s it. Your insurer calculates cost-sharing as if the provider were in-network, shows it on your explanation of benefits, and pays the provider directly.1Cornell Law School. 4 CCR 735-1-A – Your Rights and Protections Against Surprise Medical Bills If the insurer and the provider can’t agree on the rest, they go to arbitration. You are not part of that.
If You Get a Bill Anyway
Start with the provider’s billing department. Tell them the charge is protected under Colorado’s surprise billing law or the federal No Surprises Act and ask them to correct it. Many bills get fixed at this step. Under Colorado regulation, a provider or facility that overcharged you has to refund the money within 60 days of being notified.9Cornell Law School. 6 CCR 1011-1-2-A – Surprise Billing Disclosure
Before you call, pull together the bill, your insurance card, your explanation of benefits, and any letters or messages from the provider. If billing won’t fix it, move to a formal complaint.
How to File a Complaint
Colorado Division of Insurance
For issues with your insurance company, contact the Colorado Division of Insurance at 303-894-7490, or 800-930-3745 from outside the Denver metro area. You can also file online through the DOI’s consumer portal. Complaints about a specific doctor’s or provider’s billing conduct go to the Division of Professions and Occupations, which the DOI will point you toward.10Colorado Division of Insurance. File a Complaint
Federal No Surprises Help Desk
You can also file federally by calling the No Surprises Help Desk at 1-800-985-3059, which offers help in more than 350 languages, or by submitting online through CMS. Keep your confirmation number. CMS will contact you within 60 days if it needs more from you, and if the issue is under state jurisdiction it may refer your complaint to the Colorado Division of Insurance.11Centers for Medicare & Medicaid Services. Submit a Complaint
File even when the amount is small. Regulators use complaint data to spot patterns and target enforcement, so a single report can help other patients too.