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Surprise Medical Bills and the No Surprises Act
If you got a surprise bill from an out-of-network provider you did not choose, federal law likely limits what you owe. Here is how the No Surprises Act protects you and how to dispute a bill that looks wrong.
Written for patients who received a surprise or balance bill.
The No Surprises Act, effective January 1, 2022, protects patients from surprise medical bills for emergency services and for certain non-emergency services received at in-network facilities. It also created a federal Independent Dispute Resolution (IDR) process so providers and insurers can settle their own payment disputes without billing you for the difference.
The core protection is simple: for covered care, you generally owe only your in-network cost-sharing, even when an out-of-network provider was involved.
Most important deadline
120 days from the initial bill date to start a dispute.
The patient-provider dispute resolution (SDR) process must be initiated within this window.
- Dispute a surprise bill within
- 120 days of the initial bill date
- SDR applies to balances of
- $25 to $400
- SDR administrative fee
- $25 (refunded if you prevail)
- SDR decision typically within
- 30 days
Are you a provider, biller, or hospital?
Step one
Who qualifies for NSA protections?
The No Surprises Act covers most people with private insurance, but not government programs. Confirm you are protected before you dispute a bill.
You are likely protected if…
- Patients receiving emergency services at any facility
- Patients receiving non-emergency services from out-of-network providers at in-network facilities
- Air ambulance services
- Patients with private health insurance (fully-insured or self-insured)
NSA protections do not apply to…
- Traditional Medicare beneficiaries (Parts A and B)
- Medicaid beneficiaries
- VA or TRICARE beneficiaries
- Ground ambulance services (not yet covered)
When it happens
Common NSA scenarios
These are the situations the law was written to cover. If your bill fits one of them, the No Surprises Act probably applies.
- Emergency room visits at out-of-network hospitals
- Out-of-network anesthesiologist, radiologist, or pathologist at an in-network hospital
- Out-of-network assistant surgeon
- Lab work sent to an out-of-network facility
- Air ambulance transport
Your rights
What you owe, and what to do
For covered care, you owe in-network cost-sharing only (copay, coinsurance, and deductible), based on the median in-network rate. That amount counts toward your in-network deductible and your out-of-pocket maximum.
Dispute within 120 days
- 1
Verify NSA applicability
- Confirm the service date was January 1, 2022 or later
- Verify you have private health insurance
- Confirm the circumstances qualify (emergency, or non-emergency at an in-network facility)
- Check whether you signed a proper consent-to-balance-bill form
- 2
Contact the provider
- Contact the provider's billing department immediately
- Reference the No Surprises Act
- Request that the bill be adjusted to in-network cost-sharing
- Document all communications
- 3
File a federal or state complaint
- File a complaint with HHS at cms.gov/nosurprises
- File with your state insurance department if your state has a balance-billing law
- Provide the bill, your EOB, and your correspondence with the provider
- 4
Patient-provider dispute resolution (SDR)
- For disputed bills between $25 and $400
- Use an HHS-certified SDR entity
- Must be initiated within 120 days
- A $25 administrative fee applies (refunded if you prevail)
- A decision typically arrives within 30 days
Check for a consent form
Before you dispute
Documentation checklist
Gather these before you contact the provider or file a complaint. Complete records make your dispute far stronger.
- Original bill from the provider
- Explanation of Benefits (EOB) from insurance
- Insurance card showing coverage dates
- Any consent forms signed at the appointment
- Communication records with provider billing
- Communication records with your insurance company
- Date and details of the service
Reference & tools
Key NSA resources
No Surprises Help Desk
1-800-985-3059
Call for assistance with surprise bills, filing complaints, and understanding your rights under the NSA.
Keep reading
Related guides
NSA negotiation and IDR (for providers and billers)
Our B2B service for open negotiation and federal IDR on underpaid NSA claims.
ReadERISA appeals
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ReadACA / Marketplace appeals
For individual marketplace plans.
ReadAppeal tips and FAQ
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ReadAppeal deadlines
Every filing window, in one reference.
ReadAppeals glossary
Plain-English definitions of ERISA, IDR, QPA, SPD, and the rest.
ReadDisclaimer
This guide is for informational purposes only and does not constitute legal or medical advice. Appeal It Now provides administrative support and appeal preparation services only; we are not a law firm. Please consult a qualified professional for advice specific to your situation.
Version 1.0 · Updated May 2026