The No Surprises Act, explained
Since January 1, 2022, the federal No Surprises Act has protected most people from surprise out-of-network bills. Here's what it covers and how to use it.
Updated October 11, 2026 · General information, not legal advice.
What it covers
- Emergency care, including at an out-of-network emergency room
- Out-of-network doctors at an in-network hospital or surgery center, like anesthesiologists or radiologists, unless you gave advance written consent where allowed
- Air ambulance services (ground ambulances aren't covered)
What you pay
For covered surprise bills, you only owe your normal in-network cost-sharing: your copay, coinsurance or deductible. The provider and your insurer settle the rest between themselves.
If you're uninsured or paying yourself
You have the right to a good faith estimate before scheduled care. If the final bill is at least $400 more than the estimate, you can start a dispute within 120 days of the bill.
How to complain
Call the No Surprises Help Desk at 1-800-985-3059 or file online with CMS. Include the bill, your insurance statement and any estimate you were given.
Questions
Does the No Surprises Act cover ground ambulances?
No. Air ambulances are covered, but ground ambulance bills are not, though some states have their own protections.
Can a doctor ask me to waive my No Surprises protections?
For some non-emergency care, out-of-network providers can ask for written consent in advance. They can't for emergency care, or for services like anesthesia and radiology at an in-network facility.