The No Surprises Act Explained — Your 2026 Rights

What Is the No Surprises Act?

The No Surprises Act is a federal law that took effect January 1, 2022 to protect patients from unexpected out-of-network medical bills — often called "surprise bills" or "balance bills." Before this law, patients frequently received enormous bills from out-of-network providers they had no choice about using, such as an out-of-network anesthesiologist at an in-network hospital or an out-of-network ER physician at an in-network facility.

The law prohibits these providers from billing patients more than their in-network cost-sharing amounts (their copayment, coinsurance, or deductible) in the situations it covers. Any payment dispute between the provider and the insurance company must be resolved through arbitration — not by billing the patient for the difference.

What the No Surprises Act Covers

• Emergency services at any hospital, regardless of whether the hospital or the treating physician is in your network — your cost cannot exceed your in-network cost-sharing amount
• Non-emergency services at an in-network facility from out-of-network ancillary providers — this includes out-of-network anesthesiologists, radiologists, pathologists, hospitalists, and assistant surgeons at an in-network hospital or ambulatory surgical center
• Air ambulance services from out-of-network air ambulance providers that participate in health insurance plans
• Good faith estimates for uninsured or self-pay patients scheduling care at least 3 business days in advance

• Ground ambulance services — these remain largely unprotected federally as of 2026 (some states have separate protections)
• Medicare, Medicaid, TRICARE, VA health care — these programs have existing protections
• Out-of-network facilities you chose knowingly — if you chose to go to an out-of-network hospital when in-network options were available
• Non-emergency services where you signed a consent form agreeing to out-of-network billing from a specific provider

The Good Faith Estimate — Your Right Before Scheduled Care

If you are uninsured or choosing not to use insurance for a service, providers must give you a written Good Faith Estimate of the expected cost before providing the service — as long as it is scheduled at least 3 business days in advance. This estimate must include expected charges from all providers involved in your care.

If your final bill exceeds the Good Faith Estimate by $400 or more, you can dispute the charges through a federal Patient-Provider Dispute Resolution process. This is a formal right — use it.

What To Do If You Receive a Surprise Bill

• Do not pay immediately. Determine whether the bill involves services or providers covered by the No Surprises Act before making any payment.
• Review the bill to identify whether the out-of-network provider was at an in-network facility or provided emergency services.
• Contact your insurance company and ask whether this claim was processed correctly under the No Surprises Act. Request a written explanation of benefits.
• File a complaint with CMS if you believe a provider is violating the No Surprises Act — call 1-800-985-3059 or visit cms.gov/nosurprises.
• Contact your state insurance commissioner — many states have additional balance billing protections that go beyond the federal law.
• Send a written dispute referencing the No Surprises Act using our free Dispute Letter Generator.

Consent Forms — Read Before You Sign

The No Surprises Act includes an important exception: for non-emergency services at in-network facilities, an out-of-network provider can ask you to sign a consent form waiving your balance billing protections. If you sign this form, you agree to be billed at out-of-network rates. You are never required to sign this form — you can always request an in-network provider instead. Never sign a consent form under pressure, especially if you don't understand what you are waiving.

Frequently Asked Questions