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Say you went to an in-network hospital, and a bill shows up from a doctor you never met. It is much higher than you expected. The No Surprises Act may cover you. It does not cover everything, so the details matter.
What the No Surprises Act Covers
Which bills does the No Surprises Act stop?
CMS says the law protects you in most cases from unexpected out-of-network bills. That includes emergency room visits and air ambulance rides. It also covers non-emergency care from an out-of-network provider at an in-network hospital, hospital outpatient department, or surgery center.
What does it leave out?
Ground ambulances, mostly. CMS says ground ambulance services generally aren’t covered by the federal billing protections. Some states have their own rules, so check yours.
How to Dispute a Bill Under the No Surprises Act
What is a good faith estimate?
If you are uninsured or paying on your own, providers must give you one. The rule has applied since January 1, 2022. You should get it within 1 business day if the service is 3 to 9 business days away. For care 10 or more days out, the window is 3 business days. Emergencies and walk-ins are exempt.
When can you dispute a bill?
CMS says you can dispute a bill that is $400 or more above your estimate. You must be uninsured or self-pay and have an estimate. The care must be on or after January 1, 2022. The bill must be dated within the last 120 days.
The fee is $25, and it is not refundable. An independent reviewer then decides what you owe.
Who do you call about a surprise bill?
Start with the CMS No Surprises Help Desk at 1-800-985-3059. It answers billing questions and takes complaints. The help desk is the place to ask what to do next if you have insurance, since the $400 dispute process does not cover insured patients.
What should you do before you pay?
Ask for an itemized bill. Keep your estimate, your insurance card, and every letter. Don’t pay until you know whether the charge is allowed. The 120-day clock starts with the bill date, so note it.
Editor’s Take
Medical bills are written in a language most people don’t speak. The No Surprises Act gives you a few clear rights, but the deadlines are short. If you are saving for medical costs, our guide to HSA and FSA limits shows how much you can set aside.
