Check before paying
If the situation looks protected, ask the insurer and provider to explain the bill before you pay it.
Surprise medical bill
That surprise bill may need a second look.
The No Surprises Act can limit balance billing in specific emergency, in-network facility, and air ambulance situations. Start by checking what kind of care you received and who billed you.
What's banned
Balance billing in three places.
The No Surprises Act bans balance billing in three specific situations:
- Emergency care - many emergency services are protected even when the provider is out of network.
- Out-of-network providers at in-network facilities - some out-of-network clinicians at in-network facilities cannot balance-bill you when the federal protection applies. Waiver and notice rules matter.
- Air ambulance - out-of-network air ambulance services may be subject to in-network cost-sharing rules.
The result, when the protection applies, is generally in-network cost-sharing. The provider and insurer handle the remaining payment dispute through their own process.
If you got a surprise bill anyway
Filing a complaint.
Call your insurer
Ask whether No Surprises Act protections apply and whether the claim should be reprocessed.
Call the provider
Tell them why you believe the protection may apply. Ask for a written explanation or corrected bill.
File a federal complaint
If neither side fixes it: file at cms.gov/medical-bill-rights or call 1-800-985-3059.
State complaint too
Many states stack additional balance-billing protections. Find your state's route.
Read waivers carefully
Some out-of-network providers ask for notice-and-consent forms. Read before signing and ask what it changes about your bill.
FAQ
Common questions.
Does the No Surprises Act apply to ground ambulance?
Federal No Surprises Act protections are different for ground ambulance than air ambulance. Some states have their own ground ambulance balance-billing protections, so check your state route.
What if I signed a notice-and-consent form?
If you signed a written waiver for non-emergency post-stabilization care, that out-of-network provider can balance-bill you. But waivers are not allowed for emergency care, anesthesia, radiology, pathology, or assistant surgeons even with a signed waiver.
Does this apply to my employer self-funded plan?
Yes. The No Surprises Act applies to most ERISA self-funded plans the same way it applies to fully-insured plans.
How long do I have to file?
There's no strict federal deadline, but file as soon as possible. If the provider sends the bill to collections, the federal complaint window may close in practical terms.
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