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The No Surprises Act: your protection against surprise medical bills

Since 2022 you're protected from most surprise out-of-network bills — what's covered, the one big gap, and what to do if you get one anyway.

What the No Surprises Act does

Since January 1, 2022, the federal No Surprises Act has banned the most common surprise medical bills. Before it, you could go to an in-network hospital and still get hit with huge out-of-network charges from a doctor you never chose — an anesthesiologist or radiologist who happened to be out of network. That practice, called balance billing, is now illegal in most situations.

What's protected

Emergency care — you can't be balance-billed for emergency services, even at an out-of-network hospital. You pay only your normal in-network cost-sharing.
Out-of-network providers at an in-network facility — the anesthesiologist, radiologist, pathologist, or assistant surgeon you didn't pick can't bill you their out-of-network rate.
Air ambulance — covered by the ban on balance billing.

The big gap: ground ambulances

The most important exception to know: ground ambulance rides are not covered by the No Surprises Act. They remain one of the most common sources of surprise bills, so an ambulance trip can still leave you with a large out-of-network charge. (You can also waive your protections by signing a consent form to see an out-of-network provider for non-emergency care — read anything you're asked to sign.)

Your right to a Good Faith Estimate

If you're uninsured or paying cash, the Act gives you another tool: for scheduled care you can request a Good Faith Estimate of the cost in advance, and the provider must give you one in writing. If your final bill is at least $400 more than the estimate, you can dispute it through the federal patient-provider dispute resolution process.

This pairs well with the hospital's published prices — you can check the estimate against what the hospital charges others before you agree. How hospital price transparency works →

What to do if you get a surprise bill anyway

Don't pay it right away. Surprise bills that violate the Act are not valid — paying can make them harder to undo.
Compare it to your insurer's explanation of benefits to see what should have been covered.
Call the federal No Surprises Help Desk at 1-800-985-3059 to report a violation, or file a complaint at cms.gov.
Ask the provider to reprocess the claim as in-network cost-sharing, as the law requires.

Does it apply to me?

The No Surprises Act mainly protects people with private or employer health plans, and the uninsured or self-pay. If you have Medicare or Medicaid, you already had strong protections against balance billing, so the Act's rules are mostly aimed at other coverage. Either way, you should never quietly pay a surprise out-of-network bill without checking. How to fight a hospital bill →

Frequently asked questions

Does the No Surprises Act cover ambulance rides?

Air ambulances are covered, but ground ambulances are not — they're the single biggest gap in the law and remain a common source of surprise bills. A ground ambulance trip can still leave you with a large out-of-network charge.

What is a Good Faith Estimate?

If you're uninsured or paying cash, you can ask for a written estimate of the cost of scheduled care before it happens. If the final bill comes in at least $400 above the estimate, you can dispute it through the federal patient-provider dispute resolution process.

What do I do if I get a surprise out-of-network bill anyway?

Don't pay it immediately. Compare it to your insurer's explanation of benefits, ask the provider to reprocess it as in-network cost-sharing, and report the violation to the federal No Surprises Help Desk at 1-800-985-3059.

Does the No Surprises Act apply if I have Medicare or Medicaid?

Medicare and Medicaid already protect enrollees from balance billing, so the Act's new rules are aimed mainly at private and employer plans and at uninsured or self-pay patients. The protections overlap, so either way you shouldn't pay a surprise bill without checking.

Prices in this guide are as of June 2026 and link to the live page for current figures. Published data is for comparison, not a quote — always confirm with the hospital. Spotted something off? Submit a correction.