Surprise Medical Bills: How the No Surprises Act Protects You

You went to an in-network hospital, did everything right — and weeks later got a bill from an out-of-network anesthesiologist you never met. Since 2022, the federal No Surprises Act has protected most people from bills like this. Here’s how it works.

What is a surprise bill?

“Balance billing” happens when an out-of-network provider bills you for the difference between their full charge and what your insurance paid. A surprise bill is a balance bill you couldn’t reasonably avoid — because it was an emergency, or because you didn’t choose the provider.

What’s protected

1. Emergency services

Your plan must cover emergency care without prior authorization and charge you no more than in-network cost-sharing, even at an out-of-network facility. Out-of-network emergency providers can’t balance bill you. This continues until you’re stable enough to be moved.

2. Non-emergency care at in-network facilities

If you have surgery at an in-network hospital or surgery center, certain out-of-network providers there — anesthesiologists, radiologists, pathologists, assistant surgeons, hospitalists and others — can’t balance bill you. You pay only your in-network cost-sharing.

3. Air ambulances

Out-of-network air ambulance providers can’t balance bill you. Ground ambulances aren’t covered by the federal law, though some states protect against those bills.

The consent exception

For some non-emergency care, an out-of-network provider can ask you to sign a notice giving up your protections. They must give you the notice in advance (generally at least 72 hours, or 3 hours for same-day appointments) with a cost estimate. You never have to sign it — and providers like anesthesiologists and radiologists at in-network facilities can’t ask you to waive your protections at all.

Uninsured or paying cash? Ask for a Good Faith Estimate

If you don’t have insurance or choose not to use it, providers must give you a Good Faith Estimate of expected costs before scheduled care (and on request). If your final bill is at least $400 more than the estimate, you can start the federal patient-provider dispute resolution process — generally within 120 days of the date on the bill.

What to do if you get a surprise bill

1. Compare it with your EOB. If the EOB says you owe in-network cost-sharing, the provider shouldn’t bill you more. See how to read an EOB.
2. Contact the provider’s billing office and say the bill appears to violate the No Surprises Act.
3. Call your insurer to confirm how the claim was processed.
4. File a complaint through the federal No Surprises Help Desk (1-800-985-3059) or online at CMS.gov/nosurprises if it isn’t resolved.
5. Don’t ignore the bill while it’s disputed — keep records of every call and letter.

What isn’t covered

• Ground ambulance bills (unless your state protects you)
• Out-of-network care you chose knowingly and consented to properly
• Your normal deductible, copays and coinsurance
• Short-term plans and some other non-ACA coverage may not follow all of these rules

Frequently asked questions

Does the No Surprises Act apply to Medicare and Medicaid?

Medicare and Medicaid already have their own rules that largely prevent balance billing, so the No Surprises Act mainly protects people with private insurance and uninsured patients.

Does my cost-sharing count toward my in-network out-of-pocket maximum?

Yes. For protected services, what you pay counts toward your in-network deductible and out-of-pocket maximum.

Can I get a Good Faith Estimate if I have insurance?

The Good Faith Estimate rules currently apply to uninsured and self-pay patients. If you’re insured, ask your plan for a cost estimate — many insurers have online price tools.

Related: Can’t pay a medical bill? · How to appeal a denied claim

Sources: CMS No Surprises Act consumer fact sheets; CMS.gov/nosurprises. For education only — not legal advice. Last reviewed October 2026.