Surprise bills and the No Surprises Act
You picked an in-network hospital and still got a bill from an out-of-network doctor you never chose. Since 2022, federal law limits what you can be charged in most of those situations — but only if you know to push back.
What is protected
The protections cover the situations where you had no realistic ability to choose.
- Emergency services, at any facility, in or out of network
- Non-emergency services from out-of-network providers at an in-network facility (anesthesia, radiology, pathology, assistant surgeons, hospitalists)
- Air ambulance services
What you should owe
In protected situations, your cost sharing is limited to the in-network amount, and it must count toward your in-network deductible and out-of-pocket maximum. The provider and insurer settle the rest between themselves through an independent dispute process — you are not part of that fight.
The consent form exception
Providers can ask you to waive these protections by signing a notice and consent form at least 72 hours in advance. It cannot be used for emergency care or for ancillary services like anesthesia. If you were handed a form at check-in and told to sign it, that timing likely fails the requirement.
How to dispute a surprise bill
Write to both the provider and your insurer citing the No Surprises Act, state that the service was emergency care or was rendered by an out-of-network provider at an in-network facility, and ask that the claim be reprocessed at in-network cost sharing.
If that fails, you can file a complaint with the federal No Surprises Help Desk or your state insurance department. Uninsured and self-pay patients also have a separate right to a good-faith estimate, and can dispute bills that exceed it by $400 or more.
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Start freeFrequently asked questions
- Does the No Surprises Act cover ground ambulances?
- Not federally. Ground ambulance rides were left out of the law, though a number of states have added their own protections.
- What if I already paid a surprise bill?
- You can still dispute it and request a refund of the amount above your in-network cost sharing. Providers are required to refund overpayments in these situations, typically within 30 days of determination.
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Informational tool — not legal, medical, or financial advice.