Surprise medical bills: your rights under the No Surprises Act

A 'surprise bill' is what you get when an out-of-network provider treats you during care you thought was covered, then bills you for the difference between their charge and what your insurer paid. Since 2022, a federal law called the No Surprises Act has made much of this illegal.

You're protected in three main situations: emergency care from an out-of-network provider or facility; out-of-network providers such as anesthesiology, radiology, pathology, or neonatology who treat you at an in-network hospital or surgery center; and air ambulance transport. In these cases you can be charged only your normal in-network cost-sharing — your usual copay, deductible, and coinsurance.

There are gaps. Ground ambulances aren't covered by the federal law, though a number of states have their own protections. And if you knowingly choose an out-of-network provider for non-emergency care, you can be asked to sign a consent form waiving these protections — read anything a provider asks you to sign before a procedure carefully, because signing can give up your right to dispute the bill later.

If you're uninsured or paying cash, you have a related right: a Good Faith Estimate of costs before scheduled care. If your final bill comes in at least $400 above that estimate, you can challenge it through a federal dispute process.

If a surprise bill lands anyway, don't rush to pay. Confirm whether the No Surprises Act applies, compare the bill against your insurer's Explanation of Benefits, and contact your insurer to reprocess it. You can also file a complaint with the federal No Surprises Help Desk at 1-800-985-3059.

Even a fully legal bill can still contain ordinary errors. ClarifyBill checks the itemized charges for duplicates, inflated quantities, and prices far above the Medicare benchmark — so you can catch both an illegal surprise bill and a padded one.