The No Surprises Act: Your Protection Against Surprise Medical Bills
The No Surprises Act took effect on January 1, 2022. It protects insured patients from many of the surprise out-of-network bills that used to wreck household budgets, and it created the first federal price transparency right for uninsured patients. Here is what is actually covered, where the gaps are, and how to dispute a bill that violates the law.
EDR Editorial Team
Reviewed by certified debt specialists
Key takeaways
- Covers emergency services, air ambulance, and most out-of-network providers at in-network facilities.
- Does not cover ground ambulance bills, which is the largest remaining surprise-billing gap.
- Uninsured patients have the right to a Good Faith Estimate before non-emergency care.
- If the final bill exceeds the estimate by $400 or more, you can dispute it through a federal process.
What the law covers
Under the No Surprises Act, you cannot be balance-billed more than your in-network cost share for emergency services, air ambulance, and out-of-network care delivered at an in-network hospital or surgery center. This includes anesthesiologists, radiologists, pathologists, and assistant surgeons you did not choose.
The law applies to almost all private group and individual insurance plans, including self-insured employer plans regulated by ERISA. It does not apply to Medicare, Medicaid, TRICARE, or the VA, which have their own balance-billing rules already.
Important gaps
Ground ambulance is excluded. This is by far the most common remaining source of surprise medical bills, and Congress has not closed the gap as of 2026. Some states (California, Florida, New York) have stronger state ambulance protections, but federal coverage is still missing.
Some elective procedures where you signed a waiver are excluded. Coverage is also weaker if you traveled out of state and used a provider that is out-of-network for both your local plan and the local in-network facility.
Good Faith Estimates for the uninsured
If you are uninsured or paying cash, providers must give you a Good Faith Estimate at least 3 business days before scheduled care. The estimate must include the primary service and any reasonably expected ancillary services. If the final bill exceeds the estimate by $400 or more, you can dispute it through the federal Patient-Provider Dispute Resolution process.
The dispute fee is $25 and must be filed within 120 days of receiving the bill. An independent reviewer compares the bill to the estimate and the prevailing rate for the service. If you win, you owe only the lesser of the estimate amount or the median in-network rate for the service in your geographic area.
How to dispute a violation
If you believe a bill violates the No Surprises Act, do not pay it under protest hoping to get reimbursed. Disputing first is faster and avoids creating a record of payment that complicates the dispute.
- Call CMS at 1-800-985-3059 to report a balance bill.
- File a complaint at cms.gov/nosurprises.
- Submit a Patient-Provider Dispute Resolution request within 120 days of the bill if you are uninsured.
- Write to the provider in writing citing the No Surprises Act and demanding correction. Many providers fold at this stage to avoid the federal process.
The bottom line
The No Surprises Act is one of the most consumer-friendly health laws in a generation. If you have been balance-billed for an emergency or by an out-of-network provider at an in-network facility, dispute it before paying. The process is free or nearly free and the success rate is high.
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