Surprise Medical Bills (Balance Billing): Your Rights Under the No Surprises Act

Quick Summary: Key Protections at a Glance

Situation	What the Law Supports
Emergency care	Protection from balance billing; no prior authorization required
Non-emergency care at in-network facilities	Certain out-of-network clinicians cannot balance bill
Air ambulance services	Balance billing protections generally apply
Ground ambulance services	Not always covered under federal rules
Uninsured or self-pay patients	Right to a good faith estimate before scheduled care
Bill ≥ $400 over estimate	Access to a federal dispute process

Introduction

A surprise medical bill, often referred to as balance billing, is an unexpected charge that can occur when a patient receives care from an out-of-network provider without realizing it in advance. The federal No Surprises Act establishes protections that limit when these bills can occur and how much patients can be charged. This article explains what surprise medical bills are, when protections apply, what rights uninsured or self-pay patients have, and what steps are supported by high-quality evidence if a bill appears incorrect.

What Is a Surprise Medical Bill?

A surprise medical bill generally occurs when:

• A patient unknowingly receives care from an out-of-network provider, or
• A patient receives care in an emergency or at an in-network facility but is treated by one or more out-of-network clinicians involved in that care.

Balance billing is the practice of charging a patient the difference between what an out-of-network provider charges and what a health plan pays. Multiple providers may bill separately for the same visit, which can result in more than one bill.

What the No Surprises Act Does

The No Surprises Act is a federal law that limits balance billing in specific situations and caps what insured patients can be charged. Verified protections include:

• Limits on balance billing in defined emergency and non-emergency situations
• Restrictions so that insured patients generally pay no more than in-network cost-sharing amounts
• Requirements for providers and facilities to give notices explaining billing protections
• Dispute resolution processes for uninsured or self-pay patients in certain circumstances

These protections apply to many group and individual health plans.

When You Are Protected From Balance Billing

Emergency Care

If you receive emergency services:

• You are protected from balance billing even if the facility or clinicians are out of network.
• You generally cannot be charged more than the in-network cost-sharing amount.
• Emergency services must be covered without requiring prior authorization.

Non-Emergency Care at an In-Network Facility

You may also be protected when you receive non-emergency care at an in-network hospital or facility but are treated by out-of-network clinicians you did not choose. This protection applies to certain ancillary services, including anesthesia, radiology, and pathology. In these situations:

• Balance billing is generally not allowed.
• Your cost-sharing is limited to in-network amounts.

Air Ambulance Services

The law includes protections for air ambulance services:

• Patients with covered plans are generally protected from balance billing for air ambulance services.
• Ground ambulance services are treated differently and are not always covered by the same federal rules.

If You Are Uninsured or Self-Pay

Patients who do not have insurance or who choose not to use insurance have the right to receive a good faith estimate before scheduled non-emergency care. A good faith estimate should include:

• Expected costs for the main service
• Costs for related services that are reasonably expected
• Information about when the care will be provided

When a Final Bill Is Higher Than the Estimate

If you are uninsured or self-pay and your final bill is at least $400 higher than your good faith estimate, federal guidance supports access to a dispute resolution process. This process reviews whether the higher charge is appropriate, subject to specific thresholds and timing requirements.

What to Do If You Think You Received a Surprise Bill

High-quality evidence supports the following steps:

• Review your explanation of benefits (EOB) if you are insured to understand what your plan paid and why.
• Contact your health plan for clarification if coverage was denied or paid differently than expected.
• Ask about the plan’s appeals process and submit required information as directed.
• Seek assistance from federal or state resources if you believe the bill violates surprise billing protections.

Where to Get Help or File a Complaint

If you believe a bill violates your protections, authoritative sources identify these options:

• Contact the federal No Surprises Act help desk.
• Reach out to your state insurance department or consumer assistance program.

These resources can explain your rights and outline available complaint or review processes.

Federal vs. State Law

Some states have their own surprise billing protections. In many cases:

• Federal law acts as a minimum standard.
• State laws may provide additional protections or processes, depending on the type of health plan and location.

Because rules vary, guidance from your state insurance department can help clarify which protections apply.

When to See a Doctor

The No Surprises Act addresses billing protections, not whether or when to seek medical care. High-quality evidence does not support delaying necessary emergency or medically indicated care due to billing concerns. Decisions about seeking care should be based on medical need, not billing uncertainty.

Frequently Asked Questions

APA Reference List

Centers for Medicare & Medicaid Services. (2022, January 3). No Surprises: Understand your rights against surprise medical bills. https://www.cms.gov/newsroom/fact-sheets/no-surprises-understand-your-rights-against-surprise-medical-bills

Centers for Medicare & Medicaid Services. (2024, November 5). How to read your medical bill. https://www.cms.gov/medical-bill-rights/help/guides/how-to-read-bill

Centers for Medicare & Medicaid Services. (2024, November 5). Medical bill rights. https://www.cms.gov/medical-bill-rights

Centers for Medicare & Medicaid Services. (2025, April 23). Ending surprise medical bills. https://www.cms.gov/nosurprises

Centers for Medicare & Medicaid Services. (2025, June 12). You have rights in an emergency room under EMTALA. https://www.cms.gov/priorities/your-patient-rights/emergency-room-rights

Commonwealth of Pennsylvania, Department of Insurance. (n.d.). Request a review of an unexpected medical bill – No Surprises Act. https://www.pa.gov/services/insurance/request-a-review-of-an-unexpected-medical-bill-no-surprises-act

Consumer Financial Protection Bureau. (2024, October 1). Consumer advisory: Pause and review your rights when you hear from a medical debt collector. https://www.consumerfinance.gov/about-us/newsroom/consumer-advisory-pause-and-review-your-rights-when-you-hear-from-a-medical-debt-collector/

HCA Florida Healthcare. (n.d.). Surprise billing protections. https://www.hcafloridahealthcare.com/legal/surprise-billing-protections

Mayo Clinic. (n.d.). No Surprises Act. https://www.mayoclinic.org/billing-insurance/no-surprises-act

U.S. Department of Labor, Employee Benefits Security Administration. (n.d.). Avoid surprise healthcare expenses: How the No Surprises Act can protect you. https://www.dol.gov/agencies/ebsa/about-ebsa/our-activities/resource-center/publications/avoid-surprise-healthcare-expenses

U.S. National Library of Medicine. (n.d.). Understanding your hospital bill. MedlinePlus Medical Encyclopedia. https://medlineplus.gov/ency/patientinstructions/000881.htm