13 Jan Surprised By Your Medical Bill? Know Your Rights

January 13, 2026 ~ If you have ever been surprised by a medical bill, this blog will help you understand your rights. Surprise medical bills are common and often arrive long after you get medical care. You can get surprise bills even when you follow your insurance plan’s rules.

In both emergency and non-emergency situations, part of your care may be provided by a health care professional you did not choose and who is not in your insurance plan’s network, such as an anesthesiologist, radiologist, or consulting physician.

Before the No Surprises Act (NSA), these out-of-network providers could bill patients their full, undiscounted rates, leaving many people with unexpected and unaffordable bills. While some states passed laws to protect patients, protections varied. Since it took effect on January 1, 2022, the NSA has provided nationwide protections against many types of surprise medical bills.

How does the NSA protect you?

The NSA limits how much you can be charged for certain out-of-network medical services by:

• Requiring private health insurance plans to cover out-of-network surprise medical bills, and
• Prohibiting health care providers from billing patients more than their in-network cost-sharing amount for those services.

Under the law, out-of-network providers must send bills directly to your insurance company. The insurance company treats the providers as if they are in-network. After getting paid by your insurance company, the provider may only bill you for your regular in-network co-payment, co-insurance, or deductible amount.

What does the NSA cover?

The NSA applies to both emergency and certain non-emergency medical services.

Emergency services include care provided in an emergency room and services related to active labor. The law also applies to emergency air ambulance services. However, it does not apply to ground ambulance services.

Non-emergency services include many services provided by out-of-network providers at an in-network facility, such as:

• Anesthesiology
• Pathology
• Radiology and imaging
• Laboratory services
• Pre-operative and post-operative care
• Certain out-of-network telehealth services

What should you do if you get a surprise medical bill?

Knowing your rights is an important first step. If a bill is not properly identified as a surprise medical bill under the NSA, you may need to take action.

You can start by contacting your insurance company or the health care provider to request that the bill be reviewed and processed correctly. In some cases, this may resolve the issue.

If the issue is not resolved, you can contact the No Surprises Help Desk for assistance. The Help Desk is run by the U.S. Department of Health & Human Services (HHS), and can review surprise medical bills that are new, unpaid, or already in collections. If a bill falls under the NSA, the Help Desk may develop a plan to help resolve the issue and may communicate directly with the health care provider, the insurance company, the debt collector, or some combination of the three.

The preferred way to submit a bill for review is through the Help Desk’s online portal, and using a Google Chrome web browser is recommended.

When submitting a bill for review, you should be prepared to provide:

• Insurance card (front and back)
• Relevant insurance policy information
• Any Explanation of Benefits (EOBs) related to the care you got
• The medical bill or bills related to the care you got
• If the bill has been sent to collections, any related debt collection notices or communications

Submitting complete documentation may help determine whether the bill is covered by the NSA and identify next steps.

If you have questions or cannot submit a complaint online, you may also contact the Help Desk by phone at 1-800-985-3059. If the federal government determines that a provider charged more than the allowed in-network amount, the provider may face fines of up to $10,000 per violation.

What else should you know?

For certain non-emergency services, out-of-network providers may ask you to waive your protections under the NSA. If you decline to waive these rights, the provider may refuse to provide non-emergency care.

However, you cannot be asked to waive your rights for certain services, including:

• Anesthesiology
• Pathology
• Diagnostic services
• Situations where no in-network provider is available

If a provider requests a waiver, they must give you a written notice explaining your rights, describing the services to be provided, and estimating the costs. This notice must generally be provided at least 72 hours before the service, or no later than 3 hours before the service if it is scheduled for the same day.

What if I am uninsured or choose not to use insurance?

If you are uninsured or choose not to use insurance, health care providers are required to give you a good faith estimate of the expected cost of your care. If the final bill exceeds that estimate by more than $400, you have 120 days to file a dispute with HHS.

What about Medicare and Medicaid?

The NSA does not apply to people covered by Medicare or Medicaid, as those programs already include similar protections.

For more information about navigating health insurance coverage, visit the Health Insurance module at CancerFinances.org.

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