What is the No Surprises Act?
Last updated September 3, 2026.
The federal law in force since January 2022 that made the worst billing ambushes illegal: emergency care bills at in-network rates even at out-of-network ERs, out-of-network clinicians at in-network hospitals cannot balance bill you, and air ambulances are shielded. For the uninsured and self-pay, it created the good faith estimate: a written cost estimate when you schedule 3+ business days ahead or simply ask, with a federal dispute process if the final bill runs $400 or more over it. CMS runs the complaint line (7 days a week, via its medical-bill-rights page) for violations. Not covered: ground ambulances and care you knowingly book out-of-network. Pymander is a free AI doctor, 24/7 by text, and can help you check whether a bill breaks the Act.
What to do
- Emergency bill at out-of-network rates? Dispute it: that is banned.
- Uninsured? Demand the good faith estimate: it creates dispute rights.
- $400+ over the estimate? Federal dispute process: keep the estimate.
- Call the CMS complaint line: real humans, 7 days a week.
Related questions
- What is balance billing?
- Can I get a cost estimate before a medical procedure?
- What is a surprise medical bill?
- Why is my ER bill so high?