By Qamar S, 15 years in US medical billing · Last reviewed September 24, 2026
The No Surprises Act protects you from most surprise out-of-network bills for emergency care, for care from out-of-network doctors at in-network hospitals and surgery centers, and for air ambulance rides. In those cases you can only be billed your normal in-network cost-sharing. If you are uninsured or paying yourself, you have the right to a written Good Faith Estimate, and you can dispute a bill that comes in at least $400 higher than the estimate.
Your rights in one box: Emergency care = in-network prices, even at an out-of-network ER · Out-of-network doctor at an in-network hospital = in-network prices (unless you validly agreed otherwise) · Air ambulance = protected, ground ambulance generally not · Uninsured/self-pay = Good Faith Estimate + dispute if the bill is $400+ higher · Help line: 1-800-985-3059.
What the No Surprises Act covers
| Situation | Protected? |
|---|---|
| Emergency care at any hospital ER, in or out of network | Yes |
| Out-of-network anesthesiologist, radiologist, pathologist or assistant surgeon at an in-network hospital or surgery center | Yes |
| Air ambulance | Yes |
| Ground ambulance | Generally no (some states have their own protections) |
| Scheduled visit to an out-of-network doctor’s office that you chose | No |
In protected situations, you pay only what you would pay in network: your normal deductible, copay and coinsurance. The provider and your insurer must settle the rest between themselves.
When can a provider ask you to give up your protections?
For some non-emergency care, an out-of-network provider can ask you to sign a notice and consent form giving up your protections. The rules are strict: you must get the form in advance, it must show an estimate, and you can refuse to sign. For certain services, such as anesthesia, radiology, pathology, emergency medicine and assistant surgeons, providers are not allowed to ask you to waive your protections at all.
From the billing side: if a hospital hands you a stack of forms on the day of surgery, read anything titled “Surprise Billing Protection Form” or “Notice and Consent” before you sign. You are allowed to say no and ask for an in-network provider. When I see a surprise bill that the patient “agreed to,” it almost always traces back to a form signed in a hurry.
Good Faith Estimates if you are uninsured or self-pay
If you don’t have insurance, or you tell the provider you won’t use it, they must usually give you a written Good Faith Estimate of the expected charges. When you schedule at least 3 business days ahead, you should receive it before your appointment.
How to dispute a bill that is much higher than the estimate
You can use the federal patient-provider dispute resolution process if all of these apply:
- you received a Good Faith Estimate
- your bill is at least $400 more than the estimate (for any one provider)
- you start the dispute within 120 calendar days of the date on the bill
You pay a $25 fee. If you win, the fee is subtracted from what you owe. While the dispute is open, the provider cannot send your bill to collections or charge late fees. Start at the CMS dispute page.
What to do if you get a surprise bill
- Don’t pay it yet. Compare it with your insurer’s Explanation of Benefits (EOB). Our guide to reading an EOB shows how.
- Check if it’s a protected situation using the table above.
- Call the provider’s billing office and say: “This was an emergency” or “This was at an in-network facility, so the No Surprises Act applies. Please rebill my insurer and limit my bill to in-network cost-sharing.”
- Call your insurer and ask them to reprocess the claim under the No Surprises Act.
- File a complaint if it’s not fixed: call the No Surprises Help Desk at 1-800-985-3059 or submit a complaint through CMS.
Frequently asked questions
Does the No Surprises Act cover ground ambulances?
Generally no. Some states have their own ground ambulance protections, so check your state’s insurance department.
Does it apply to all health plans?
It applies to most private health plans, including employer plans and marketplace plans. Medicare and Medicaid already have their own protections against balance billing.
How long do I have to dispute a bill that’s higher than my Good Faith Estimate?
120 calendar days from the date on the bill.
Sources
- CMS: Your rights and protections against surprise medical bills
- CMS: Dispute a medical bill (patient-provider dispute resolution)
- CMS: No Surprises Act rules and fact sheets
*This guide is educational and is not legal advice. State laws may give you extra protection. See our Disclaimer.*