Surprise Medical Bills: Your Rights Under the No Surprises Act
Last updated September 10, 2026.
Since January 2022, federal law bans most surprise medical bills. The No Surprises Act stops out-of-network providers from billing you more than in-network costs for emergency care, out-of-network care at in-network facilities, and air ambulance services. You pay only your plan's in-network cost-sharing, and the provider cannot balance bill you for the rest.
What the No Surprises Act covers
The law protects you in three main situations. First, emergency services at any hospital or freestanding emergency department, whether in-network or not. You cannot be billed more than your plan's in-network emergency copay or coinsurance, even if the facility or the doctors who treat you are out-of-network.
Second, non-emergency care at an in-network hospital or surgery center when an out-of-network provider treats you. Common examples include anesthesiologists, assistant surgeons, radiologists, and pathologists. You pay only the in-network rate. The out-of-network provider must accept that amount as payment in full.
Third, air ambulance services from out-of-network operators. Ground ambulances are not covered by this federal law, though some states have their own rules. The law applies to people with employer plans, ACA marketplace plans, and many other private insurance types. Medicare and Medicaid have separate protections.
What the law does not cover
Ground ambulance bills are not protected. You can still receive surprise bills for ground ambulance transport, although some states limit this. Check your state insurance department website or call 211 for local rules.
The law does not apply if you knowingly choose an out-of-network provider for non-emergency care and sign a written consent form at least 72 hours before the service. The form must list the provider's name, the out-of-network cost estimate, and your in-network options. You can revoke consent anytime before the service.
Post-stabilization care after an emergency is covered only if you cannot travel or if no in-network provider is available. Once stable, if the hospital offers an in-network option and you choose to stay with an out-of-network doctor, you may receive a surprise bill. The hospital must give you written notice and get your consent.
How much you pay under the protections
You owe the same copay, deductible, or coinsurance you would pay if the provider were in-network. Your insurer calculates this using a recognized amount, often the plan's median in-network rate for that service in your area. That payment counts toward your in-network deductible and out-of-pocket maximum.
The out-of-network provider and your insurer negotiate the rest directly. The provider cannot send you a balance bill for the difference. If they try, that is illegal under federal law.
You should receive an explanation of benefits from your insurer showing the protected amount. Keep that document in case the provider contacts you for additional payment.
Good faith estimates for uninsured and self-pay patients
If you have no insurance or do not plan to use your insurance, providers and facilities must give you a good faith estimate of costs when you schedule care or when you ask. The estimate is due within one business day for scheduling at least three days out, or within three business days for scheduling ten or more days out.
The estimate must list expected charges for the primary service and any other items or services you will need as part of that care, such as lab work, anesthesia, or facility fees. It must include provider names, service codes, and expected costs.
If your final bill is at least $400 higher than the estimate, you can dispute it through the federal patient-provider dispute resolution process. You have 120 days from the bill date to start a dispute. The process costs a small fee, currently $25, which you get back if you win.
How to dispute a surprise bill that violates the law
If you receive a bill that you believe breaks the No Surprises Act, first call your insurer. Ask them to confirm whether the service should have been covered at the in-network rate. Insurers must apply the law automatically, but errors happen. Most insurers have a dedicated line for surprise billing questions.
If your insurer agrees you should not owe the balance, they will contact the provider. If the provider does not withdraw the bill, you can file a complaint with the federal government. Go to cms.gov and search for No Surprises Help Desk, or call 1-800-985-3059. The complaint process is free.
You can also file a complaint with your state insurance department. Many states had surprise billing laws before the federal rule, and state regulators can enforce violations. Find your state department at usa.gov or call 211 for the phone number.
Do not ignore the bill while you dispute it. Send the provider a letter stating you believe the bill violates federal law, and keep a copy. If the bill goes to collections, dispute it in writing with the collection agency and the credit bureaus. Federal protections mean you should not owe the money.
When you still need to negotiate or get help
For bills not covered by the law, such as ground ambulance charges or care you consented to in writing, you may need to negotiate. Call the billing office and ask if they offer a discount for prompt payment or a payment plan. Many providers reduce bills by 20 to 40 percent if you ask.
Hospital financial assistance programs must help patients under 200 percent of the federal poverty level, and many help those with higher incomes. Ask for a financial assistance application. Nonprofit hospitals are required by law to have these programs.
Community health centers, legal aid groups, and patient advocates can help you understand your rights and dispute bills. Call 211 or search findahealthcenter.hrsa.gov for free and low-cost local help. A free AI doctor consult by text through Pymander can also help you understand what happened and what steps to take next.
Common questions
Does the No Surprises Act apply to emergency room bills?
Yes. The No Surprises Act requires that you pay only your plan's in-network cost-sharing for emergency services, even if the hospital or the doctors who treat you are out-of-network. The law applies to all emergency care at any hospital or freestanding ER, regardless of whether the facility is in your insurance network.
Can a doctor still surprise bill me if I go to an in-network hospital?
No, not for most services. If you receive care at an in-network hospital or surgery center and an out-of-network provider treats you without your written consent, the No Surprises Act protects you. You pay only the in-network rate. This commonly applies to anesthesiologists, radiologists, pathologists, and assistant surgeons.
Are ground ambulance rides covered by the No Surprises Act?
No. The federal No Surprises Act covers only air ambulance services. Ground ambulance bills are not protected, so you can still receive surprise bills for ground transport. Some states have their own laws that limit ground ambulance billing, so check with your state insurance department or call 211 for local rules.
What do I do if a provider sends me a surprise bill anyway?
Call your insurance company first and ask them to confirm whether the service should be covered at the in-network rate under the No Surprises Act. If they agree you are protected, they will contact the provider. If the bill is not resolved, file a complaint at cms.gov or call 1-800-985-3059. You can also file with your state insurance department. Keep all records and do not pay the disputed amount.
Can I be surprise billed if I sign a consent form?
Yes, but only under strict conditions. You must receive a written consent form at least 72 hours before a non-emergency service, listing the provider's name, the estimated out-of-network cost, and your in-network options. You can revoke consent anytime before the service. Emergency care and out-of-network care you did not consent to in writing are always protected.
What is a good faith estimate and who gets one?
A good faith estimate is a written cost estimate for uninsured patients or patients who do not plan to use insurance. Providers must give you one when you schedule care or when you ask. If your final bill is at least $400 more than the estimate, you can dispute it through a federal process within 120 days. The dispute costs $25, refunded if you win.
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