Surprise Medical Bills: Your Rights Under the No Surprises Act

What Is a Surprise Medical Bill?

A surprise medical bill (or “balance bill”) occurs when you receive care from an out-of-network provider without your knowledge or consent, and they bill you the difference between their charge and what your insurance paid. Before the No Surprises Act, these bills averaged $600-$2,600 — and some reached tens of thousands.

Common scenarios that generated surprise bills:

• An out-of-network anesthesiologist at your in-network hospital
• Emergency room care at any hospital (you can’t choose during an emergency)
• An out-of-network radiologist reading your imaging
• An assistant surgeon you never met billing separately
• Out-of-network lab work processed at a facility chosen by the hospital, not you

The No Surprises Act: What It Covers

Effective January 1, 2022, the No Surprises Act protects patients in three key scenarios:

1. Emergency Services

You’re protected from balance billing for ALL emergency services, regardless of:

• Whether the hospital is in-network or out-of-network
• Whether individual providers at that hospital are in-network
• Whether you were stabilized and then received post-stabilization care

What you pay: Your normal in-network cost-sharing (copay/coinsurance) — nothing more.

2. Non-Emergency Services at In-Network Facilities

If you go to an in-network hospital or ASC, you’re protected from surprise bills from out-of-network providers you didn’t choose:

• Anesthesiologists
• Radiologists
• Pathologists
• Assistant surgeons
• Hospitalists
• Diagnostic services (labs, imaging)

Exception: If you give written consent to be treated by an out-of-network provider (at least 72 hours before the procedure), you can waive this protection. Never sign these consent forms unless you fully understand the cost implications.

3. Air Ambulance Services

Out-of-network air ambulance providers cannot balance bill you. You pay only in-network cost-sharing.

Note: Ground ambulances are NOT yet covered by the No Surprises Act.

Good Faith Estimates: Your Right to Know the Price

The No Surprises Act also requires providers to give uninsured or self-pay patients a Good Faith Estimate (GFE) of expected charges:

• Must be provided within 1-3 business days of scheduling (depending on timing)
• Must include all expected charges from all providers involved
• If the final bill exceeds the GFE by $400 or more, you can dispute it through the Patient-Provider Dispute Resolution process

How to Request a Good Faith Estimate:

1. Tell the provider you’re self-pay (or that you’d like a GFE regardless of insurance status)
2. Ask for it in writing with all provider charges included
3. Request it at least 3 days before your scheduled service
4. Keep it — you’ll need it if you need to dispute the final bill

How to Dispute a Surprise Bill

If You Have Insurance:

1. Don’t pay the surprise bill. You’re likely protected.
2. Call your insurance company and report the balance bill. Reference the No Surprises Act.
3. File a complaint with CMS at 1-800-985-3059 or online at cms.gov/nosurprises.
4. Contact your state insurance department — many states have additional protections beyond federal law.

If You’re Uninsured/Self-Pay:

1. Compare the final bill to your Good Faith Estimate.
2. If it exceeds the GFE by $400+, initiate the Patient-Provider Dispute Resolution (PPDR) process within 120 days.
3. File the dispute through CMS — a $25 fee applies (refunded if you win).
4. The dispute is resolved by an independent reviewer within 30 business days.

What the Law Does NOT Cover

• Ground ambulance services
• Services where you knowingly signed an out-of-network consent form
• Workers’ compensation claims
• Care at out-of-network facilities you chose (non-emergency)
• Surprise bills received before January 1, 2022

Protect Yourself Proactively

1. Always verify network status for your facility AND all providers involved
2. Never sign out-of-network consent forms unless you truly understand the cost
3. Request a Good Faith Estimate before every procedure
4. Compare prices on CarePrices.ai to know what’s reasonable before you receive care
5. Keep all documentation — EOBs, GFEs, consent forms, bills

The Bottom Line

The No Surprises Act is a major step forward for patient protection. If you receive a surprise bill that you believe violates the law, don’t pay it — dispute it. The process exists specifically to protect you.

Related Reading

• FAQ — More about healthcare costs and patient rights
• Compare Prices — Know fair prices before you receive care