Surprise medical bills and the No Surprises Act
The No Surprises Act is a federal law that protects most people with health coverage from certain surprise out-of-network bills. If you got an out-of-network bill for emergency care, or from a doctor you didn't choose at an in-network hospital, federal law may protect you.
Updated October 4, 2026 · 1 min read
The short version
- Most people with coverage are protected from surprise out-of-network bills for emergency care, and from doctors they didn't choose at an in-network hospital.
- If the law applies, you should only owe your in-network share.
- Uninsured? A bill $400 or more over your Good Faith Estimate can be disputed within 120 days.
The law has applied since January 1, 2022. If it covers your bill, you should only owe what you'd pay in-network. Medicare and Medicaid have their own, separate protections.
What does the No Surprises Act protect?
- Emergency care, including at an out-of-network emergency room
- Non-emergency care from out-of-network providers at an in-network hospital or surgery center, like an anesthesiologist, radiologist or assistant surgeon you didn't pick, unless you validly agreed in advance to waive the protection (and some providers can't ask you to)
- Air ambulance services (ground ambulances aren't covered by the federal law, though some states protect them)
Is your bill a protected surprise bill?
- Your EOB shows the provider as out-of-network, but the visit was an emergency or at an in-network facility
- The provider is billing you for the difference between their charge and what your insurer paid (balance billing)
- Your cost-sharing was calculated at out-of-network rates
“This bill is for [emergency care / care at an in-network facility] on [date]. I believe it's protected under the No Surprises Act, so I should only owe my in-network cost-sharing of [amount from EOB]. Please correct the balance or explain in writing why the law doesn't apply.”
What if you're uninsured or paying yourself?
You have the right to a good faith estimate of costs before scheduled care. If the final bill from a provider or facility is at least $400 more than its estimate, you can start the federal patient-provider dispute resolution process within 120 days of receiving the initial bill.
Where can you get help?
The federal No Surprises Help Desk (1-800-985-3059) takes questions and complaints. Your state insurance department can also help, especially if your plan is state-regulated.
Rules change and exceptions exist. This guide is educational, not legal advice. For specific situations, check with the help desk or your state insurance department.
Educational information only, not legal, medical or financial advice. Rules vary by state and plan.