Updated October 15, 2026
What is the No Surprises Act? The No Surprises Act is a federal law, in effect since January 2022, that protects people with private health insurance from most surprise out-of-network bills. It covers emergency care, care from out-of-network providers at in-network hospitals and surgery centers, and air ambulance services. In those situations, you pay only your normal in-network cost-sharing. The law also entitles uninsured and self-pay patients to a Good Faith Estimate before scheduled care.
Before this law, many patients went to an in-network hospital and later received large bills from doctors they never chose, like an anesthesiologist or radiologist who didn’t take their insurance. This guide explains how the law protects you, where the gaps are, and what to do if you get a bill that seems wrong.
Key Takeaways
- You can’t be balance billed for emergency care, even at an out-of-network hospital.
- At an in-network hospital or surgery center, certain out-of-network providers, like anesthesiologists and radiologists, can’t bill you more than your in-network cost-sharing.
- These providers can never ask you to give up your protections. For other non-emergency care, you can only waive them in writing, with advance notice.
- Ground ambulance rides aren’t covered by the federal law, though some states protect you.
- If you’re uninsured or paying yourself, you’re entitled to a Good Faith Estimate and can dispute a bill that comes in at least $400 higher.
What Is a Surprise Medical Bill?
A surprise bill happens when you get care from an out-of-network provider or facility you didn’t choose, or didn’t know was out of network, and then get billed for the difference between what they charged and what your plan paid. This is called balance billing.
Common examples include:
- Emergency care at an out-of-network hospital
- An out-of-network anesthesiologist, radiologist, or lab at an in-network hospital
- An out-of-network air ambulance
The No Surprises Act moves payment disputes in these situations to your insurer and the provider, so you aren’t caught in the middle.
When You’re Protected
Emergency care
Emergency services are covered at in-network cost-sharing at any hospital emergency department or urgent care center licensed to provide emergency care, whether it’s in network or not. Your plan can’t require prior authorization for emergency care. Protections can also extend to some care you receive after you’re stabilized.
Out-of-network providers at in-network facilities
When you get non-emergency care at an in-network hospital, hospital outpatient department, or ambulatory surgery center, these providers can’t balance bill you and can never ask you to waive your protections:
- Emergency medicine, anesthesiology, pathology, radiology, and neonatology
- Assistant surgeons, hospitalists, and intensivists
- Diagnostic services, including lab work and imaging
- Any provider, if no in-network provider was available
For other out-of-network providers at an in-network facility, you can be billed more only if you received a written notice and signed a consent form at least 72 hours before your care (or 3 hours, for care scheduled the same day).
Air ambulance
Out-of-network air ambulance services are covered at in-network cost-sharing.
In all of these situations, you pay only your normal in-network copay, coinsurance, and deductible, and those payments count toward your in-network out-of-pocket maximum (CMS).
What the Law Doesn’t Cover
- Ground ambulance: Federal protections don’t apply to ground ambulance rides, but many states have their own laws.
- Care you knowingly chose: If you agreed in writing to see an out-of-network provider after getting proper notice, you may owe more. This doesn’t apply to emergency or ancillary care.
- Excluded coverage types: Medicare, Medicaid, CHIP, TRICARE, and VA health care aren’t covered by the No Surprises Act, because they already have their own balance-billing protections. Short-term health plans and health care sharing ministries generally aren’t covered either.
Which Plans Are Covered
The law’s billing protections apply to most private health coverage, including:
- Employer plans, whether insured or self-funded
- Individual plans from HealthCare.gov, state marketplaces, or directly from an insurer
- Federal Employees Health Benefits plans
Not sure what type of plan you have? Call the number on your insurance card.
Good Faith Estimates for Uninsured and Self-Pay Patients
If you’re uninsured or plan to pay for care yourself, providers must give you a Good Faith Estimate of expected charges when you schedule care at least 3 business days in advance, or when you ask for one. The estimate should list the items and services you’re expected to receive, with billing codes and expected charges.
If your final bill is at least $400 more than your Good Faith Estimate, you can start a patient-provider dispute within 120 days of the date on the bill. There’s a $25 fee (CMS). Our guide on how to estimate out-of-pocket costs explains how to use your estimate.
What to Do If You Get a Surprise Bill
- Check your Explanation of Benefits. Compare it with the bill to see what your insurer paid and what you’re being asked to pay. See understanding your Explanation of Benefits.
- Contact the provider and your insurer. Ask whether the claim was processed under No Surprises Act protections. Many errors are fixed at this step.
- Keep records. Note dates, names, and reference numbers for every call.
- File a complaint if it isn’t fixed. Call the federal No Surprises Help Desk at 1-800-985-3059 or submit a complaint through CMS. If you’re uninsured or self-pay, use the dispute process above.
For step-by-step help with a specific bill, see our guide to surprise medical bills.
Frequently Asked Questions
What is the No Surprises Act designed to do?
It protects people with private insurance from surprise out-of-network bills for emergency care, certain care at in-network facilities, and air ambulance services. It also gives uninsured and self-pay patients the right to a Good Faith Estimate.
Can I still get a surprise medical bill?
Yes, in some cases. Ground ambulance rides aren’t covered by federal protections, and you may owe more if you agreed in writing to see an out-of-network provider after getting notice. Medicare, Medicaid, and other government programs have their own protections.
Can a provider ask me to waive my No Surprises Act protections?
Not for emergency care, or for anesthesiologists, radiologists, pathologists, labs, and other ancillary providers at an in-network facility. For other non-emergency care, a provider must give you written notice and get your signed consent in advance.
Does the No Surprises Act apply to Medicare and Medicaid?
No. Medicare, Medicaid, CHIP, TRICARE, and VA health care aren’t covered by the No Surprises Act, because they already limit what providers can bill you.
How do I dispute a bill above my Good Faith Estimate?
If you’re uninsured or self-pay and your bill is at least $400 more than your estimate, you can start a patient-provider dispute within 120 days of the bill date. There’s a $25 fee.
Who do I contact about a surprise bill?
Start with your provider and your insurer. If the problem isn’t resolved, call the No Surprises Help Desk at 1-800-985-3059.
Learn More with Patient.com
Knowing your rights under the No Surprises Act can save you money and stress. Patient.com breaks down billing protections, insurance rules, and your options when something goes wrong, so you can handle medical bills with confidence.
