Quick answer. Four sets of rules can help with a medical bill: the federal No Surprises Act (most emergency and some out-of-network bills), the good faith estimate and a dispute if you are uninsured or self-pay and the bill is $400 or more over it, a nonprofit hospital's financial assistance policy (IRS section 501(r)), and New Jersey Charity Care at NJ acute care hospitals. Answer the questions below to see which rules and deadlines to read about.
Check what applies to your bill
Answer the questions to see the rules that match.
The checker matches your answers to the published rules and works out dates. It can't tell you what you qualify for: the provider, hospital, insurer or agency decides. Weekends and holidays aren't adjusted.
Surprise bills: the No Surprises Act
Since January 1, 2022, the federal protections ban surprise bills for most emergency services, including post-stabilization services, from out-of-network providers or facilities; for covered non-emergency services from out-of-network providers at certain in-network hospitals, hospital outpatient departments, ambulatory surgical centers and critical access hospitals; and, generally, for covered air ambulance services from out-of-network providers. For these, you can't be charged more than your plan's in-network cost-sharing. Ground ambulance services are not covered by the Act (CMS key protections). The No Surprises Help Desk is 1-800-985-3059.
No insurance or self-pay: the good faith estimate and the $400 dispute
If you're uninsured or not using insurance, the provider usually must give you a good faith estimate when you schedule care at least 3 business days ahead, or when you ask. It's due 1 business day after scheduling for care 3 to 9 business days out, and 3 business days after scheduling (or your request) otherwise. If the bill is at least $400 more than that provider's estimate, you may be able to start patient-provider dispute resolution within 120 days of getting your initial bill (CMS). While it is open, the provider may not send the bill to collections, must pause collections already under way and can't charge late fees (CMS provider guidance). Check CMS for how to start a dispute and any fee.
Hospital financial assistance policies (IRS section 501(r))
A hospital organization treated as a 501(c)(3) charity must have, for each facility, a written financial assistance policy covering emergency and other medically necessary care: who is eligible, how charges are figured, how to apply and what happens if a bill isn't paid. The policy, application and a plain language summary must be online and free on paper, and billing statements must carry a notice (IRS). An eligible patient can't be charged more than the amounts generally billed to insured patients for that care (501(r)(5)). Before extraordinary collection actions such as credit reporting, liens, garnishment or a lawsuit, the hospital has a 120-day notification period and a 240-day application period counted from the first post-discharge billing statement; a complete application suspends those actions until it decides (501(r)(6)).
New Jersey Charity Care
Charity Care is not health insurance. It offers free or reduced-charge care for necessary inpatient and outpatient care at all New Jersey acute care hospitals, for residents with no coverage or partial coverage who aren't eligible for Medicaid or other coverage (NJ Department of Health). Separate bills from private physicians, anesthesiology, radiology interpretation and outpatient prescriptions may not be reduced.
| Income, percent of HHS guideline | Patient pays | Family of 1 | Family of 4 |
|---|---|---|---|
| 200% or less | 0% | up to $31,920 | up to $66,000 |
| Over 200% to 225% | 20% | up to $35,910 | up to $74,250 |
| Over 225% to 250% | 40% | up to $39,900 | up to $82,500 |
| Over 250% to 275% | 60% | up to $43,890 | up to $90,750 |
| Over 275% to 300% | 80% | up to $47,880 | up to $99,000 |
| Over 300% | 100% | over $47,880 | over $99,000 |
Assets must not exceed $7,500 for an individual or $15,000 for a family; extra can be spent down on the bill. On the 20 to 80 percent tiers, qualified medical bills over 30 percent of gross annual income may count as assistance. Apply at the hospital's business or admissions office up to one year from the date of service or discharge; the hospital may accept a completed application up to two years after, and decides within 10 working days of a complete application (fact sheet; N.J.A.C. 10:52-11). Income is measured over the 12 months, 3 months or 1 month before service, using the lowest you document. Questions: 1-866-588-5696 or 609-292-4709. Dollar amounts above use the 2026 HHS poverty guidelines; ask the hospital which year's guidelines apply to your date of service.
Insurance denials
File an internal appeal within 180 days of the denial notice; the insurer has 30 days for care not yet received and 60 days for care already received (HealthCare.gov). After a final denial, you can ask for external review in writing within 4 months; standard reviews are decided within 45 days and the insurer must accept the result (HealthCare.gov).
Medical debt on credit reports: unsettled
No settled rule can be given here. The CFPB's January 2025 rule to remove most medical bills from credit reports was vacated by the U.S. District Court for the Eastern District of Texas on July 11, 2025 (CFPB archive). In October 2025 the CFPB published an interpretive rule saying federal law generally preempts state limits on what goes into credit reports; it says the rule does not have the force of law and that courts can decide questions about specific state laws (Federal Register). Whatever happens, you can get your free reports at AnnualCreditReport.com and dispute errors.
Sources
- CMS: No Surprises Act key protections (revised June 2026)
- CMS: Surprise billing and protecting consumers
- CMS: Know your medical bill rights when not using insurance (modified Oct. 5, 2026)
- CMS: Providers, what to expect when a patient starts payment dispute resolution (modified Aug. 26, 2026)
- IRS: Financial assistance policies (FAPs)
- IRS: Financial assistance policy and emergency medical care policy, section 501(r)(4)
- IRS: Limitation on charges, section 501(r)(5)
- IRS: Billing and collections, section 501(r)(6)
- NJ Department of Health: New Jersey Charity Care (Hospital Care Payment Assistance), updated May 14, 2026
- NJ Department of Health: Charity Care fact sheet (January 2026)
- N.J.A.C. 10:52-11, Charity care (NJ Department of Health)
- HHS: Annual update of the HHS poverty guidelines, Federal Register 2026-00755 (Jan. 15, 2026)
- HealthCare.gov: Internal appeals
- HealthCare.gov: External review
- CFPB: CFPB finalizes rule to remove medical bills from credit reports (archived; notes the July 11, 2025 vacatur)
- Federal Register 2025-19671: Fair Credit Reporting Act; Preemption of State Laws (Oct. 28, 2025)
General information checked November 2026 against the CMS, IRS, NJ Department of Health, HHS, HealthCare.gov and CFPB pages above. Not legal, medical, insurance or financial advice, and not affiliated with any agency. The checker runs in your browser; nothing you enter is sent or saved.
Common questions
Does the No Surprises Act cover ground ambulance bills?
No. CMS says ground ambulance services are not covered by the No Surprises Act, though other remedies may be available. It does cover most emergency services, covered non-emergency care from out-of-network providers at certain in-network facilities, and covered air ambulance services from out-of-network providers.
I don't have insurance. Can I dispute a bill that is much higher than my estimate?
CMS says that if a provider's bill is at least $400 more than that provider's good faith estimate, you may be able to use the patient-provider dispute resolution process. You have to start within 120 days of getting your initial bill, and you need the estimate in writing.
Does every hospital have to offer financial assistance?
Hospital organizations treated as 501(c)(3) charities must have a written financial assistance policy for each hospital facility under IRS section 501(r), and must publicize it. Other hospitals may have their own programs. Ask the billing office for the policy and its plain language summary.
What income qualifies for New Jersey Charity Care?
The NJ Department of Health publishes a sliding scale based on the HHS poverty guidelines: free care at 200 percent or less, and patient shares of 20 to 80 percent between 200 and 300 percent. Assets must be under $7,500 for an individual or $15,000 for a family. The hospital decides each application.
How long do I have to apply for Charity Care?
Up to one year from the date of outpatient service or inpatient discharge, under N.J.A.C. 10:52-11.13. A hospital may, at its discretion, accept a completed application up to two years after.
Will medical debt show up on my credit report?
It is unsettled. The CFPB's 2025 rule removing most medical bills from credit reports was vacated by a federal court on July 11, 2025, and later CFPB guidance on state laws is not binding and leaves questions to the courts. Check your own reports at AnnualCreditReport.com and dispute any errors.