Medical Bill 'No Surprises Act' & Good Faith Estimate Dispute Checker
Check if a surprise out-of-network emergency bill, anesthesiologist charge, or bill exceeding your Good Faith Estimate by $400+ is illegal under federal law.
1. Enter Your Case Details Runs in your browser
2. Your result Live Output
- Illegal Under Federal No Surprises Act: Emergency room visit (or air ambulance) billed at out-of-network 'balance billing' rates above my in-network deductible/copay — Out-of-network emergency providers are strictly barred from balance-billing patients beyond normal in-network cost-sharing.
- Illegal Ancillary Balance Billing: Scheduled procedure at an IN-NETWORK hospital, but received an out-of-network bill from an anesthesiologist, radiologist, pathologist, or assistant surgeon — Ancillary providers at in-network facilities can NEVER ask you to waive No Surprises Act protections.
- Eligible for Federal PPDR Dispute Reduction: Uninsured / Self-Pay patient: Final bill exceeded the written Good Faith Estimate (GFE) by $400 or more — Under 45 C.F.R. § 149.620, if a self-pay bill exceeds the Good Faith Estimate by $400+, you can trigger Patient-Provider Dispute Resolution within 120 days.
- Demand Itemized UB-04 / CMS-1500 Statement: Provider sent a lump-sum summary bill without CPT/HCPCS itemized codes (often hiding duplicate charges) — Under HIPAA right of access, you are entitled to a complete itemized statement with CPT codes.
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3. How the rule works
Who this is for
Patients who received an unexpected out-of-network bill after emergency care or after care at an in-network hospital, and uninsured or self-pay patients whose bill was much higher than the Good Faith Estimate.
Ground ambulance bills are mostly outside the federal law, though some states cover them.
What to have ready
- The itemized bill with billing codes.
- Your Explanation of Benefits, or your Good Faith Estimate if self-pay.
- Any consent forms you signed before treatment.
- The date you received the bill.
The rule
The No Surprises Act, in force since January 2022 (42 U.S.C. § 300gg-111 and following), protects people with most private health plans from balance billing for emergency services, for out-of-network providers at in-network hospitals and ambulatory surgical centers, and for air ambulances. In these cases the patient pays only the in-network cost-sharing amount. For some non-emergency services a provider can ask the patient to waive the protection with advance notice and consent, but not for ancillary services such as anesthesiology, radiology, pathology, neonatology and assistant surgeons.
Uninsured and self-pay patients are entitled to a Good Faith Estimate when care is scheduled at least three business days ahead, or on request (45 C.F.R. § 149.610). If the final bill is at least $400 more than the estimate for any provider, the patient can start the federal patient-provider dispute resolution process within 120 calendar days of receiving the bill (45 C.F.R. § 149.620). The CMS No Surprises Help Desk is 1-800-985-3059.
Read the official text:
- 42 U.S.C. § 300gg-111
- 45 C.F.R. § 149.620 (patient-provider dispute resolution)
- CMS: No Surprises Act consumer information
Worked example: self-pay estimate versus bill
An uninsured patient received a Good Faith Estimate of $2,400 from a surgery center for a scheduled procedure. The bill arrives on May 10 for $3,100.
Difference = $3,100 - $2,400 = $700 Threshold = $400 or more above the estimate -> eligible Deadline to start = 120 days after May 10 = September 7 Administrative fee = $25 (paid by the patient to start) While pending = provider may not send the bill to collections
Common mistakes
- Paying an out-of-network bill for emergency care before checking whether the protections apply.
- Signing a consent form for an ancillary provider such as an anesthesiologist, which cannot waive the protection anyway.
- Comparing the bill total with the total estimate across providers. The $400 test applies per provider or facility.
- Missing the 120-day window for dispute resolution.
Limits of this tool
- Coverage depends on plan type; some plans and ground ambulances are outside the federal law, though state laws may help.
- The checklist does not check whether the in-network cost-sharing was calculated correctly.
- Dispute resolution can award a different amount than you hope for.
Sources were last checked in October 2026. Statutes are amended often; if the official text differs from this page, the official text controls.
4. Clear Next Steps & Statutory Action Plan
- Ask for an itemized bill and compare it with your Explanation of Benefits or Good Faith Estimate.
- If you were balance-billed for protected care, tell the provider and insurer in writing and call the CMS help desk.
- If you are uninsured and the bill exceeds the estimate by $400 or more, start dispute resolution within 120 days.
5. Frequently Asked Statutory Questions (42 U.S.C. § 300gg-111 et seq. (Federal No Surprises Act); 45 C.F.R. § 149.620 ($400 GFE Dispute Rule))
What if I never received a Good Faith Estimate?
Providers must give uninsured and self-pay patients an estimate when care is scheduled at least three business days in advance, or when asked. You can report a missing estimate to CMS.
Does the law cover ambulances?
It covers air ambulances. Ground ambulances are not covered by the federal balance-billing protections, although some states regulate them.
Can I be sent to collections during a dispute?
Providers may not move the bill to collections while a patient-provider dispute is pending, and must pause late fees.