Surprise Medical Bills & No Surprises Act Rights

Red flags and urgency levels

• UrgentSeek care today

  An unexpected out-of-network balance bill after emergency care, after care at an in-network hospital, hospital outpatient department, or ambulatory surgical center, or after an air ambulance ride — while you used most types of private insurance.

• UrgentSeek care today

  You are uninsured or self-pay, you have a good-faith estimate, and the bill is $400 or more above that estimate with an initial bill dated within about the last 120 days — ask about patient-provider dispute resolution promptly.

• UrgentSeek care today

  A collector is pursuing a surprise bill you are actively disputing under federal protections — ask that collections pause and document the dispute.

• SoonMake an appointment within days to a couple of weeks

  You are asked to sign a notice-and-consent form that may waive certain No Surprises Act protections for some allowed non-emergency or post-stabilization services — read it carefully before signing.

• SoonMake an appointment within days to a couple of weeks

  An out-of-network ground ambulance bill (generally outside federal NSA protections unless state law says otherwise) — still compare documents and ask about state rules and financial assistance.

• MonitorKeep track and mention it at your next visit

  A bill that matches your EOB patient-responsibility amount for deductible, coinsurance, or copay — that alone is not automatically a No Surprises Act violation.

• For people with most private insurance, federal protections generally cover unexpected out-of-network bills from emergency room visits.
• Protections also generally cover certain non-emergency services from out-of-network providers when care is related to a visit at an in-network hospital, hospital outpatient department, or ambulatory surgical center — for example many ancillary clinicians.
• Air ambulance services are generally included in federal surprise-billing protections; ground ambulance services generally are not (state law may differ).
• If you do not have or do not use insurance, providers usually must give a good-faith estimate when you schedule care in advance or when you ask for one.
• For some allowed non-emergency or post-stabilization services, a notice-and-consent form can waive certain protections — not for emergency services or certain ancillary providers.
• An EOB is not a bill; compare the provider bill to the EOB patient-responsibility balance for that claim before you pay.
• Insured patients with a coverage dispute often use the plan appeal path; uninsured or self-pay patients comparing a bill to a good-faith estimate may use patient-provider dispute resolution instead — they are different paths. See also our guides on EOBs and insurance appeals.
• Educational information only — not legal advice. State surprise-billing rules may add protections beyond federal law.

1. 1

   Decide which path fits: you used insurance (NSA complaint and/or plan appeal) versus you were uninsured or self-pay (good-faith estimate and possible patient-provider dispute resolution).

2. 2

   Gather documents: itemized bill, EOB if insured, good-faith estimate if uninsured or self-pay, notice-and-consent forms if any, and dated notes of calls.

3. 3

   Compare the bill line-by-line to the EOB or good-faith estimate for the same date of service before paying.

4. 4

   If you used insurance and received an unexpected out-of-network balance bill in a protected setting, contact the provider billing office and your plan, and consider a CMS No Surprises complaint.

5. 5

   If you are uninsured or self-pay and the bill is $400 or more above your good-faith estimate, ask about patient-provider dispute resolution (generally within about 120 days of the initial bill; there may be a filing fee such as $25).

6. 6

   During an active patient-provider dispute, collections are generally paused — tell any collector you are in the dispute process.

7. 7

   If a collector contacts you about a surprise medical bill or you see surprise charges on a credit report, you can dispute and submit a CFPB complaint.

8. 8

   Call the CMS No Surprises Help Desk at 1-800-985-3059 or use CMS complaint tools if you believe a provider, facility, or insurer is not following the rules.

9. 9

   Check whether your state has additional surprise-billing protections; state rules may apply alongside federal law.

• “Was any part of this visit billed as out-of-network, and at which facility?”
• “Can I get an itemized bill and a copy of any notice-and-consent form I signed?”
• “If I am uninsured or self-pay, can you provide a good-faith estimate before scheduled care?”
• “Can billing pause collections while I dispute this under No Surprises Act or patient-provider dispute resolution rules?”
• “Who in your billing office handles No Surprises Act questions, and what reference number should I use?”

• No Surprises ActCenters for Medicare & Medicaid Services
• Know Your Rights Against Surprise Medical BillsCenters for Medicare & Medicaid Services
• Know Your Medical Bill RightsCenters for Medicare & Medicaid Services
• How to Dispute a Medical BillCenters for Medicare & Medicaid Services
• Submit a No Surprises Act ComplaintCenters for Medicare & Medicaid Services
• Model Disclosure Notice Regarding Patient Protections Against Surprise BillingCenters for Medicare & Medicaid Services
• Medical Bill Guides and ResourcesCenters for Medicare & Medicaid Services
• Know Your Medical Bill Rights When Not Using InsuranceCenters for Medicare & Medicaid Services
• Overview of Rules and Fact Sheets (No Surprises)Centers for Medicare & Medicaid Services
• What Should I Do If I Get a Surprise Medical Bill?Consumer Financial Protection Bureau
• I Can't Pay My Medical Bill — What Are My Options?Consumer Financial Protection Bureau

• Understanding medical bills & EOBs
• Appealing an insurance denial
• Getting your medical records
• Urgent care vs. emergency room
• How to prepare for a doctor's appointment
• How to prepare for a specialist appointment