The No Surprises Act: When You Can Refuse to Pay

What is protected

• Emergency services at any facility, in or out of network, including the stabilization that follows.
• Out-of-network clinicians at an in-network facility — the anesthesiologist, radiologist, pathologist, assistant surgeon and hospitalist you did not choose.
• Air ambulance transport.

In those cases you owe only your normal in-network cost sharing, and that amount counts toward your in-network deductible and out-of-pocket maximum. The provider and insurer settle the rest between themselves through an independent dispute resolution process you are not part of.

The waiver you should not sign

For some non-emergency services, a provider may ask you to sign a notice and consent form giving up these protections. It must be given to you in advance, with a cost estimate. You are never required to sign it, and signing it means agreeing to out-of-network charges. For emergency services, and for the ancillary clinicians listed above, such waivers are generally not permitted at all.

If a form is handed to you at registration and you do not fully understand it, decline to sign. Care cannot be withheld from you in an emergency for refusing.

Good faith estimates, if you are self-pay

If you are uninsured or choosing not to use insurance, you are entitled to a written good faith estimate of expected charges before scheduled care. If the final bill exceeds that estimate by a substantial margin — the threshold is set at $400 above the estimate — you can use the patient-provider dispute resolution process to challenge it.

Ask for the estimate in writing and keep it. It is one of the few pieces of leverage a self-pay patient has.

If you get a bill you think is prohibited

1. Do not pay it. Paying can complicate the dispute.
2. Call the provider's billing office, say the words "No Surprises Act," and ask them to reprocess.
3. Call your insurer and ask them to reprocess at in-network cost sharing.
4. File a complaint with the federal No Surprises Help Desk and with your state insurance regulator.

Frequently Asked Questions

Does it apply to all insurance?

It applies to most employer plans, including self-funded ones, and to Marketplace and individual plans. Medicare and Medicaid already had their own balance-billing protections.

What if I chose to go out-of-network on purpose?

Then the protection does not apply. It exists for situations where you had no meaningful choice.

Does it cover urgent care?

Only when the facility is licensed to provide emergency services. A standard urgent care center that is out-of-network is generally not covered by the act — which is why verifying network status before you walk in still matters.

How long do I have to dispute?

Deadlines apply and differ by process, so act promptly rather than waiting. For the self-pay dispute process, the window runs from the date of the bill.