Federal No Surprises Act / Colorado Out-of-Network Billing

Colorado law protects consumers from surprise medical bills.


Coloradans are protected from certain surprise medical bills under both state and federal law when a covered individual receives:

  • Most emergency services;
  • Non-emergency services from an out-of-network provider at an in-network facility, such as a hospital;
  • Service from a private ground ambulance provider (not from a fire department or government entity); and
  • Service from an out-of-network air ambulance service provider.

Colorado law and the federal No Surprises Act ban out-of-network cost-sharing (like out-of-network coinsurance or copayments) for most emergency and some non-emergency services. You can’t be charged more than in-network cost-sharing for these services.

If you want to learn more about the federal No Surprises Act, please visit the No Surprises Act website (from the Center for Medicare & Medicaid Services) to see fact sheets on what No Surprises Act rules cover, as well as additional details about consumer protections.

What are surprise medical bills?


If you have health insurance and get care from an out-of-network provider or at an out-of-network facility, your health plan may not cover the entire out-of-network cost. This can leave you with higher costs than if you got care from an in-network provider or facility.

In the past, in addition to any out-of-network cost-sharing you might owe (like coinsurance or copayments), the out-of-network provider or facility could bill you for the difference between the billed charge and the amount your health plan paid. This is called “balance billing.”

An unexpected balance bill from an out-of-network provider is called a surprise medical bill. 


Out-of-network providers and facilities may ask you to waive your balance billing protections, you do NOT have consent to out-of-network care. If you choose an out-of-network provider, the provider must give you information in advance about what your share of the costs will be and you must provide written consent to the higher costs.

You can never be asked to waive your surprise billing protections for services related to: 

  • emergency medicine
  • anesthesiology, 
  • pathology
  • radiology, 
  • neonatology; 
  • services provided by assistant surgeons, hospitalists, intensivists; 
  • diagnostic services including radiology and laboratory services; and 
  • services provided by an out-of-network provider if there is no in-network provider who can provide the service at the facility. 

Colorado law includes provisions for how health insurance carriers will reimburse providers (doctors, hospitals and other health care providers) for out-of-network emergency and non-emergency care. 

Recording of NSA Overview Webinar - January 26, 2023

NSA Overview Slides - January 26, 2023

For Colorado Consumers


If you receive a surprise bill and have questions about which law is applicable, contact our Consumer Services Division for assistance. 

303-894-7490 / 800-930-3745 (outside the Denver Metro area) DORA_Insurance@state.co.us  

Monday - Friday, 8:00 a.m. - 5:00 p.m.


Other Agencies:

For Health Care Providers and Insurance Companies


Out-of-Network Arbitration Program Main Page 

Apply to be Arbitrator for the Out-of-Network Arbitration Program - The Division is currently not accepting applications for additional arbitrators

List of Qualified Arbitrators and Fees for the Out-of-Network Payment Arbitration Program


Out-of-Network APCD Reimbursement Datasets

December 20, 2022

CO APCD Professional, Anesthesia, and Emergency Room Fee Schedule Overview and Methods (Data issued 12.2022)

December 21, 2021

CO APCD Professional, Anesthesia, and Emergency Room Fee Schedule Overview and Methods (Data issued 12.2021)

CO APCD COVID Fee Schedule Overview and Methods (Data issued 12.2021)

December 18, 2020

CO APCD Support for HB 19-1174 (2019 Service Dates)

October 21, 2020

CO APCD Calculated Allowed Amounts to Support Implementation of House Bill 19-1174 -  October 2020 Update


For Carriers - Out of Network Data Reporting

The Division is currently working to repeal Regulation 4-2-74 due to the recent passage of Senate Bill 24-135, signed by Governor Polis on March 22, 2024, which eliminated the requirement carriers to annual submit information to the Division concerning the use of out-of-network providers and out-of-network facilities and the impact on premium affordability for consumers.