Surprise medical bill? How the No Surprises Act protects you, and how to dispute it

What's happened

Many people schedule tests and procedures before year-end deductibles reset, and winter brings more emergency room visits. If a bill arrives that's far higher than you expected, a federal law may protect you.

The No Surprises Act took effect on January 1, 2022 and is still in force. The federal Centers for Medicare & Medicaid Services (CMS) runs its consumer pages and help desk, and its medical bill rights page was last updated on October 5, 2026. The law protects people with health insurance from most surprise out-of-network bills, and gives people who are uninsured or paying for themselves the right to a good faith estimate of the cost before care.

Who's affected

If you have health insurance, you're protected from unexpected out-of-network bills for:

• Emergency care. If your plan covers emergency care, you can't be charged more than your in-network cost-sharing, even at an out-of-network hospital.
• Out-of-network providers at in-network facilities, such as an anesthesiologist at your in-network hospital, hospital outpatient department or ambulatory surgery center.
• Air ambulances. Ground ambulances generally aren't covered, unless your state's law protects you.

The protections generally don't apply to short-term plans, health care sharing ministries, fixed indemnity plans, or dental-only and vision-only plans.

What the rules say

• Notice and consent. For some non-emergency care, an out-of-network provider can ask you to sign a form giving up your protections. It's your choice. If you scheduled at least 72 hours ahead, you must get the form at least 72 hours before your care.
• Some providers can never ask. Assistant surgeons, hospitalists and intensivists can't use these forms, and nor can providers of anesthesiology, pathology, radiology, neonatology, emergency medicine and lab services.
• Good faith estimates. If you're uninsured or not using insurance, providers must give you a written estimate. If you book at least 3 business days ahead, it's due within 1 business day; if you book at least 10 business days ahead, within 3 business days; and if you just ask, within 3 business days.
• The $400 rule. If your bill is at least $400 more than the estimate, you may be able to dispute it through the federal patient-provider dispute resolution process.

A worked example

This is an illustration, not a real case.

Ana has no insurance and books an MRI two weeks ahead. She tells the clinic she's paying herself, and gets a written good faith estimate of $1,200. The bill comes to $1,750, which is $550 more than the estimate. Because that's at least $400 over, she can start a dispute within 120 calendar days of the bill's date. She pays a $25 fee, and an independent reviewer decides what she should pay. If she wins, the $25 is taken off what she owes.

Ben has insurance and goes to his in-network hospital for surgery. Weeks later, an out-of-network anesthesiologist bills him $2,000 on top of his in-network cost-sharing. Anesthesiologists can't ask patients to waive their protections, so Ben shouldn't have to pay more than his in-network cost-sharing. He contacts his insurer and files a complaint with the No Surprises Help Desk.

What to do now

1. Ask for a good faith estimate if you're uninsured or paying yourself, and keep it.
2. Read any consent form before signing. You don't have to sign it, and you can call the No Surprises Help Desk on 1-800-985-3059 first.
3. Check your bill against your insurer's explanation of benefits before paying.
4. Insured? Appeal and complain. Use your plan's appeal process if a claim was wrongly denied, and file a complaint with the help desk about a surprise bill. Not having met your deductible isn't a violation.
5. Uninsured? Dispute within 120 days. Start online through the CMS portal, or send the PDF form by mail or fax. Don't send original documents.

FAQs

Can I settle with the provider during a dispute?

Yes. If you settle before the process ends, CMS says the provider must reduce your bill by at least $12.50 and tell the reviewer.

What if I win but the provider keeps billing me?

If you're still being billed, or the bill has gone to collections, file a complaint with the No Surprises Help Desk.

Does the law cover my doctor's office?

Not for the out-of-network rules, unless it's a hospital outpatient department. Those protections apply to care linked to in-network hospitals, hospital outpatient departments and ambulatory surgery centers.

Sources: CMS: medical bill rights, CMS: know your rights when using insurance, CMS: dispute a bill, 45 CFR 149.420: notice and consent, 45 CFR 149.610: good faith estimates