Federal surprise medical bill protection

No Surprises Act

Last updated: June 2026

What the No Surprises Act protects

People with commercial health insurance from surprise out-of-network bills for most emergency services.
Most emergency services from out-of-network hospitals, freestanding emergency departments, and emergency clinicians. Examples include ER physicians, radiologists, anesthesiologists, and pathologists who treat you during an emergency visit.
Commercial insurance must cover out-of-network emergency bills at the in-network rate.
The provider cannot balance bill the patient for the difference. Any consent form or financial responsibility agreement the patient signed does not override this protection. The No Surprises Act protects patients in emergency situations even if they signed such a form.
Certain air ambulance services.
Good faith estimate and dispute rights for many uninsured or self-pay patients.

It does not apply to Medicare, Medicaid, TRICARE, VA, or Indian Health Service. These programs have their own provider payment and billing rules.
It does not cover ground ambulance bills unless a state law gives extra protection.
It does not prevent coding disputes. A provider or insurer may still disagree over which billing code applies to your visit, which can affect what you owe.

You go to an in-network hospital for a scheduled surgery. The hospital assigns you an anesthesiologist (an ancillary provider) who turns out to be out of network. You did not choose that provider. The No Surprises Act protects you from a surprise bill in this situation.
Your primary care doctor's front desk schedules you for outpatient surgery and tells you the facility is in network. At the facility, some of the providers (ancillary providers) involved in your care turn out to be out of network. Because you did not choose those individual providers, the No Surprises Act still protects you from surprise out-of-network bills for their services.
Your primary care doctor's front desk schedules you for outpatient surgery and tells you the facility is in network. You assume everything is covered. You did not schedule with a specific surgeon. You only know it will be a doctor from a medical group. There is no ancillary provider in this case, only the physician performing the surgery. Then you get the bill and discover the surgeon was out of network, even though the facility was in network. Would the No Surprises Act apply? It is unclear. This is a gap in the law that can leave patients with an unexpected bill. Patients, be aware.

Do not ignore a surprise bill. Check the bill, explanation of benefits, and provider name.
Call the number on your insurance card and ask whether the No Surprises Act applies.
If the provider is balance billing you, request a three-way call between yourself, your insurance, and the provider to resolve the dispute together.
Call the CMS No Surprises Help Desk if the bill still looks wrong.
Save copies of bills, insurance explanations, payment notices, and any consent forms.