Published April 6, 2026 · Updated annually
No Surprises Act: What It Covers and How to Use It
The No Surprises Act, effective January 1, 2022, protects patients from unexpected medical bills when they receive emergency care or are treated by out-of-network providers at in-network facilities. Under this law, you can only be charged in-network cost-sharing amounts for these services, and providers cannot balance bill you for the difference. This guide explains what the law covers, what it does not, and how to enforce your rights.
What the No Surprises Act Covers
The law provides three main protections:
1. Emergency Services
All emergency services — including those at out-of-network emergency departments — are protected. You can only be charged your in-network copay, coinsurance, and deductible. This applies to:
- Emergency room visits at any hospital, including out-of-network facilities
- Air ambulance services provided by out-of-network providers
- Post-stabilization care until you can be safely transferred or give informed consent to out-of-network care
2. Non-Emergency Services at In-Network Facilities
When you go to an in-network hospital or surgery center, certain providers working there may be out-of-network (like anesthesiologists, radiologists, or pathologists). The No Surprises Act protects you from surprise bills from these out-of-network providers at in-network facilities.
Protected providers include:
- Anesthesiologists
- Radiologists and pathologists
- Assistant surgeons
- Hospitalists and intensivists
- Neonatologists
- Lab services
3. Good Faith Estimates for Uninsured Patients
If you are uninsured or self-pay, healthcare providers must give you a good faith estimate of expected charges before a scheduled service. If the final bill exceeds the estimate by $400 or more, you can dispute it through the patient-provider dispute resolution process.
What the No Surprises Act Does NOT Cover
- Ground ambulances — Ground ambulance services are not covered by the No Surprises Act. Only air ambulance is protected.
- Elective out-of-network care — If you choose to go to an out-of-network provider and sign a written consent and waiver, you may be balance billed.
- Short-term or limited benefit plans — Plans that are not regulated under the ACA may not be subject to No Surprises Act protections.
- Workers compensation claims — Medical bills from workplace injuries are handled under separate workers' comp rules.
How to File a Complaint
If you receive a surprise bill that violates the No Surprises Act:
- Contact your insurance company — Ask them to reprocess the claim at in-network rates.
- Contact the provider — Inform them that the bill violates the No Surprises Act and request an adjusted bill.
- File a complaint with CMS — Visit cms.gov/nosurprises or call 1-800-985-3059 to file a formal complaint.
- Contact your state insurance department — Many states have additional surprise billing protections that may apply.
- Use the dispute resolution process — For good faith estimate disputes, submit a dispute within 120 days of receiving the bill.
Hospital Price Transparency and the No Surprises Act
The No Surprises Act works alongside the Hospital Price Transparency Rule. Together, these laws give patients the right to know prices before receiving care and protection from unexpected bills after. Our database of hospital pricing data helps patients compare costs and make informed decisions before scheduling procedures.
Frequently Asked Questions
A surprise medical bill (or "balance bill") occurs when you receive care from an out-of-network provider and the provider bills you for the difference between their charge and what your insurance paid. Common scenarios: an out-of-network anesthesiologist at an in-network hospital, or emergency care at an out-of-network ER. The No Surprises Act now prohibits most surprise bills.
No. Ground ambulance services are specifically excluded from the No Surprises Act. Only air ambulance services are covered. Some states have their own laws protecting against surprise ground ambulance bills. Check with your state insurance department for local protections.
First, do not pay immediately. Contact your insurance company and ask them to reprocess the claim at in-network rates under the No Surprises Act. If the provider refuses, file a complaint with CMS at 1-800-985-3059 or cms.gov/nosurprises. Keep all bills, EOBs, and correspondence as documentation.
A good faith estimate is a written estimate of expected charges that healthcare providers must give to uninsured or self-pay patients before scheduled services. If the actual bill exceeds the estimate by $400 or more, you can dispute the charges through the patient-provider dispute resolution process within 120 days of receiving the bill.
/methodology