Don't pay yet
If the situation looks like one of the three protected scenarios, the bill probably isn't enforceable as written.
Surprise medical bill
That surprise bill probably isn't enforceable.
The No Surprises Act took effect January 2022. It bans balance billing in three high-risk scenarios most patients don't even realize they're in.
What's banned
Balance billing in three places.
The No Surprises Act bans balance billing in three specific situations:
- Emergency care — any emergency service from any provider, in or out of network. The bill must be calculated as if the provider were in-network.
- Out-of-network providers at in-network facilities — when you go to an in-network hospital and an out-of-network anesthesiologist, radiologist, pathologist, or assistant surgeon shows up, they cannot balance-bill you. (Some specialties — non-emergency post-stabilization care — can balance-bill if you sign a written waiver. Don't sign without reading.)
- Air ambulance — out-of-network air ambulance services are subject to the in-network cost-sharing rules.
The result: you only owe what you would have owed if everyone was in-network. The provider and your insurer figure out the rest through a federal independent dispute resolution process (IDR).
If you got a surprise bill anyway
Filing a complaint.
Call your insurer
Ask them to apply the No Surprises Act protection. They should re-process the claim at the in-network rate.
Call the provider
Tell them you believe the No Surprises Act applies. Ask them to send a corrected bill.
File a federal complaint
If neither side fixes it: file at cms.gov/medical-bill-rights or call 1-800-985-3059.
State complaint too
Many states stack additional balance-billing protections. Find your state's route.
Don't sign waivers
Some out-of-network providers ask you to sign a notice-and-consent waiver. You can refuse — and you should.
FAQ
Common questions.
Does the No Surprises Act apply to ground ambulance bills?
Mostly no — the federal No Surprises Act does not apply to ground ambulance bills (only air ambulance is federally protected). About 73.7% of patients who actually dispute a medical bill receive a correction (JAMA Health Forum, 2024), and many states have layered their own ground-ambulance balance-billing protections on top of federal law. Check your state's surprise-billing route before paying; a ground ambulance bill from an out-of-network provider may still be appealable at the state level.
What if I signed a notice-and-consent form for surprise medical bill care?
If you signed a notice-and-consent form, that out-of-network provider can balance-bill you for non-emergency post-stabilization care — but the waiver is not allowed for emergency care, anesthesia, radiology, pathology, or assistant surgeons, even with your signature. About 73.7% of patients who actually dispute a medical bill receive a correction (JAMA Health Forum, 2024). If your waiver was signed for a protected service, the No Surprises Act still applies and the bill is appealable.
Does the No Surprises Act apply to my employer self-funded plan?
Yes, the No Surprises Act applies to most ERISA self-funded employer plans the same way it applies to fully-insured plans, so surprise medical bill protections cover most U.S. workers. About 73.7% of patients who actually dispute a medical bill receive a correction (JAMA Health Forum, 2024). If your self-funded plan refuses to apply the NSA protection, the Department of Labor EBSA is the right complaint route in addition to CMS.
How long do I have to file a surprise medical bill complaint?
There is no strict federal deadline to file a surprise medical bill complaint, but file as soon as possible — if the provider sends the bill to collections, the practical window narrows. About 73.7% of patients who actually dispute a medical bill receive a correction (JAMA Health Forum, 2024). File at cms.gov/medical-bill-rights or call 1-800-985-3059. Filing also creates a paper trail that supports a state complaint or credit bureau dispute later.
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