What does the No Surprises Act protect me from, and what do I do with a surprise bill?

Which bills does the law cover?

If you have most kinds of health insurance, the No Surprises Act covers surprise out-of-network bills in three situations: emergency care, non-emergency care connected to a visit to an in-network hospital or surgery center, and air ambulance services Source 11. In those situations, you owe only what you would pay in network.

• Emergency care. At a hospital emergency department or a freestanding emergency department, an out-of-network hospital or provider may not bill you more than your in-network cost sharing: your deductible, copay and coinsurance Source 22.
• Care at an in-network hospital or surgery center. An out-of-network provider who treats you there, such as an anesthesiologist, a radiologist or a lab, may not bill you more than your in-network share either. A narrow exception for some other planned care is described below Source 33.
• Air ambulance rides. The same protection applies to air ambulance services Source 11.

When a provider bills you for the difference between its full charge and what your plan paid, that is called balance billing. Every provider and facility must post a plain-language notice of these protections on its website, give it to insured patients and name the state and federal agencies to contact about a violation Source 44.

What isn't covered?

The federal protections have gaps. Know them before you pay or argue a bill:

• Ground ambulance rides. Ambulances that travel by road were left out of the federal ban on surprise bills. A federal advisory committee sent its recommendations, and no federal fix had been found when we last checked Source 55. Some states protect you: see our guide to ambulance bills.
• Out-of-network care outside the three situations above. For example, an office visit you book yourself with an out-of-network doctor is not one of the situations the law covers Source 11.
• Some planned care you agreed to in writing. In a few cases, an out-of-network provider may bill you more if it followed strict notice and consent rules (see below) Source 33.
• People without insurance. The law helps them in a different way, through good faith estimates (see below) Source 11.

What should I pay if I get a surprise bill?

Pay only your in-network share for the care. In the situations the law covers, an out-of-network provider may not bill you more than the cost sharing you would owe in network Source 22,Source 33.

1. Compare the bill with your plan's explanation of benefits. It shows what the plan paid and what it says you owe. Our guide on how to read a medical bill shows which numbers should match.
2. Don't pay the extra amount. If the bill asks for more than your in-network share, pay nothing above that share while you sort it out.
3. Call or write to the provider's billing office. Say that the bill is for care the No Surprises Act covers and ask for a corrected bill. If you already paid more than your share, ask for the difference back.
4. Call your plan if the explanation of benefits treated the care as out of network when the law says it should cost you the in-network amount. If the plan won't fix it, you can appeal: see our guide on appealing an insurance denial.
5. Write everything down: the date, the name of the person you spoke with and what they said.

If the bill is not fixed, complain (see below).

What if I signed a form agreeing to out-of-network care?

It depends on the care and on how and when you signed. For some planned care at an in-network hospital or surgery center, an out-of-network provider may bill you more than your in-network share. It may do so only if it gave you a written notice and got your consent ahead of time Source 33.

• Timing. The minimum, counted in hours before the care, is 72 (45 CFR 149.420 (eCFR), published 2026). Shorter notice is allowed only when you book the care for the same day Source 33.
• Care the exception never covers. It never applies to emergency medicine, anesthesiology, pathology, radiology, neonatology, assistant surgeons, hospitalists, intensivists or diagnostic services such as lab work. It also never applies to care that no in-network provider at the facility could give, or to urgent needs nobody could foresee Source 33.
• After emergency care. Once you are stable, you can be asked to agree to out-of-network care only if you are able to travel to an in-network provider or facility and you give informed consent Source 22.

If the notice came too late, if the care is on the list above, or if nobody asked for your consent, these limits on what you pay still apply Source 33. Keep a copy of anything you signed.

How do I complain or get help?

• The No Surprises Help Desk. Send a question or complaint online, with copies of your bills and your explanation of benefits, through the CMS complaint form, or get help by phone at 1-800-985-3059. The Help Desk reviews it, may investigate and refers it to another federal or state agency when needed Source 66. The help line is open every day and gives help in many languages Source 11.
• The notice from your provider. It must name the state and federal agencies to contact about a violation Source 44.
• Your health plan. If the plan processed the claim as out of network, ask it to reprocess the claim, and appeal if it says no.

I don't have insurance. Does the law help me?

Yes, in a different way. If you are uninsured or pay for care yourself, you usually have the right to a good faith estimate of expected charges when you ask for one or schedule care far enough ahead Source 11. The minimum notice is 3 business days (CMS, published October 5, 2026).

If your final bill is far above the estimate, you can dispute it through a federal process for uninsured and self-pay patients. The bill must be at least $400 (CMS, published October 2, 2026) more than the estimate Source 77. While the dispute is open, the provider may not send the bill to collections Source 77.

This dispute is only for people who were uninsured or self-pay and got a good faith estimate. If you have insurance, use the protections above and your plan's appeal process. Our guide to good faith estimates explains the deadline, the fee and how to file.

Does my state add protections?

Some states have their own surprise-billing laws. Each one reaches only the health plans that state regulates. Self-funded employer plans are usually outside these state laws unless the plan opts in, and the federal law applies alongside them. Your plan or your employer's benefits office can tell you which kind of plan you have.

These are the state laws we have read in each state's official code. The sources at the end of this page give the date we last checked each one.

• Colorado. For emergency care from out-of-network providers, and for care from out-of-network providers at in-network facilities, your plan must cover you at no greater cost to you than in network, and it pays the provider directly. The rule for care at an in-network facility does not apply if you gave notice and consent under the federal rules, and the emergency rule does not apply to ambulance services (C.R.S. 10-16-704).
• Delaware. An out-of-network provider may not balance bill you for emergency care your policy covers; your deductible and copays still apply. The same is true when your insurer sends you to an out-of-network provider because the care isn't available in network (18 Del. C. 3348 and 3349).
• Illinois. For emergency care, and for covered ancillary services from an out-of-network provider at an in-network facility, you may not be billed more than your in-network cost sharing. Other out-of-network care at an in-network facility gets the same protection unless the federal notice and consent rules were followed (215 ILCS 5/356z.3a).
• Maine. For a surprise bill, or a bill for covered emergency care from an out-of-network provider, your plan may charge you only the cost sharing that applies in network. A provider telling you it is out of network does not by itself mean you chose it (24-A M.R.S. 4303-C).
• Nevada. For medically necessary emergency care, an out-of-network provider may not collect more from you than your in-network copay, coinsurance or deductible. There are exceptions, for example care at critical access hospitals and policies sold outside Nevada (NRS 439B.745).
• New Jersey. You pay no more than your in-network deductible, copay or coinsurance for emergency or urgent care. The same goes for care from an out-of-network provider at an in-network facility when no in-network provider was available there, including some lab tests. Members of self-funded plans are covered only if the plan opts in (P.L.2018, c.32).
• New York. An out-of-network provider may not bill you more than your in-network copay, coinsurance or deductible for a surprise bill or for emergency care. That includes a hospital stay that follows an emergency room visit (Financial Services Law 606).
• Texas. In a Texas-regulated HMO, PPO or EPO plan, an out-of-network provider may not bill you more than your plan's copay, coinsurance and deductible. This covers emergency care, care from facility-based providers at an in-network facility, and imaging or lab work connected to in-network care. For non-emergency care, this does not apply if you chose the out-of-network provider in writing after a full written disclosure (Tex. Ins. Code ch. 1271 and 1301).
• Virginia. No out-of-network provider may balance bill you for emergency care, or for non-emergency surgical or ancillary services from an out-of-network provider at an in-network facility. You owe only your in-network cost sharing (Va. Code 38.2-3445.01).
• Washington. No balance billing for emergency care, for some non-emergency care from out-of-network providers at in-network facilities, or for air ambulance services, and nobody may ask you to sign away these protections (RCW 48.49.020).

We have not verified other states' laws yet. Your state's insurance department can tell you what applies to your plan, and an attorney can tell you how a law applies to your bill.