The No Surprises Act became federal law in January 2022. It's one of the strongest consumer protections for medical billing in decades. But most patients don't know it exists — which means they're paying bills they legally don't owe.
This guide explains exactly what the No Surprises Act covers, what it doesn't cover, and how to use it to challenge surprise medical bills.
The No Surprises Act protects patients from unexpected out-of-network bills in specific situations. Before this law, patients could receive enormous bills from out-of-network providers (like an anesthesiologist or radiologist) who they never chose and never knew were involved in their care.
Under the No Surprises Act, in most cases, you cannot be billed more than your in-network cost-sharing amount for emergency care or care at an in-network facility — even if the provider who treated you was out-of-network.
You cannot be charged more than your in-network cost-sharing (deductible + copay) for emergency services — regardless of the hospital's network status. If you go to any ER in the US, you pay in-network rates, even if that hospital is out-of-network with your insurer.
This is the big one. If you go to an in-network hospital for a planned surgery, but your anesthesiologist or radiologist is out-of-network (and you didn't know or didn't choose them), you can only be billed in-network rates.
Air ambulance bills are notoriously huge. The No Surprises Act caps what you can be billed for out-of-network air ambulance rides to your in-network cost-sharing amount.
Important: Hospitals can ask you to sign a waiver accepting out-of-network charges. You are NOT required to sign this waiver for most emergency or surgical procedures. If you signed a waiver under pressure or without understanding it, it may not be enforceable.
| Situation | Before No Surprises Act | After No Surprises Act |
|---|---|---|
| ER visit, out-of-network hospital | $18,000 bill | In-network copay ($250) |
| Out-of-network anesthesiologist at in-network hospital | $4,200 balance bill | $0 (in-network rates apply) |
| Air ambulance (out-of-network) | $40,000+ bill | In-network cost-sharing only |
| Radiologist reading scans at in-network hospital | $1,400 balance bill | $0 (covered under Act) |
For scheduled (non-emergency) care, providers must give you a Good Faith Estimate of expected costs before treatment. If your final bill is more than $400 above the Good Faith Estimate, you can dispute it through the Patient-Provider Dispute Resolution process.
One patient received a Good Faith Estimate of $3,200 for a planned procedure. The final bill was $5,900 — $2,700 above the estimate. After filing a dispute under the No Surprises Act, the bill was reduced to $3,400.
MyClearBill analyzes your bill for out-of-network charges, surprise billing patterns, and No Surprises Act violations — and generates a dispute letter.
Upload your bill and check it instantly →Disputes under the No Surprises Act have time limits. For Good Faith Estimate disputes, you have 120 calendar days from receiving the bill to initiate a dispute. Don't wait — the sooner you act, the stronger your position.
And remember: if the bill is already in collections, the No Surprises Act and FDCPA give you additional rights to challenge it.