Short answer. The federal No Surprises Act bans surprise bills for most emergency care, for covered non-emergency care from out-of-network providers at certain in-network facilities, and for covered out-of-network air ambulance services. In those cases you generally owe only your plan's in-network cost-sharing. Ground ambulances aren't covered. If you're uninsured or self-pay, a separate rule lets you dispute a bill that is at least $400 over your good faith estimate.
What the law covers
According to the CMS key protections summary:
- Emergency care. Surprise bills are banned for most emergency services, including care after you're stabilized.
- Non-emergency care at in-network facilities. Protections generally apply to out-of-network providers working at in-network hospitals, hospital outpatient departments, ambulatory surgical centers and critical access hospitals.
- Air ambulance. Covered services from out-of-network air ambulance providers.
When the law applies, your out-of-network cost-sharing "cannot be greater than" your in-network cost-sharing.
What it doesn't cover
CMS says plainly: "Ground ambulance services are not covered by the No Surprises Act." It adds that other remedies may be available. Care your plan doesn't cover at all is also a different question from a surprise bill.
The consent form question
For some planned care, a provider can ask you to sign a notice and consent to give up these protections. CMS says providers may not create their own version of that form, may never ask you to waive protections for ancillary services such as anesthesiology or an assistant surgeon, or for unforeseen urgent needs, and can't seek consent before you're stabilized in an emergency. If you signed something, get a copy and check it against those limits.
If you have insurance: steps
- Match the bill to your plan's explanation of benefits. Look at what the plan says you owe for that service, and whether the provider was in or out of network.
- Ask the provider in writing why you were billed more than your in-network share, and whether the No Surprises Act applies to the visit.
- Call your plan and ask how it processed the claim under the Act.
- Call the No Surprises Help Desk at 1-800-985-3059 if it isn't resolved. CMS also takes complaints online.
- Keep notes of each call: date, name, what was said.
If you're uninsured or paying yourself
CMS says providers generally must give you a good faith estimate when you schedule care at least three business days ahead, or when you ask. If the final bill is at least $400 more than the estimate, you may be able to use the patient-provider dispute resolution process, and you must start within 120 days of getting your initial bill (CMS). CMS suggests keeping the estimate somewhere safe and taking a photo of it. You need it in writing to use the dispute process.
While you sort it out
Ask the provider to hold the bill while you check, and keep paying any part you agree you owe. If you can't afford the part you do owe, ask about the hospital's financial assistance policy (see hospital financial assistance and NJ Charity Care).
Two examples (hypothetical amounts)
Insured. Planned surgery at an in-network hospital. Weeks later, a bill arrives from an out-of-network anesthesiologist for $2,300 beyond what the plan paid. The plan's in-network coinsurance for that service would have been $300. Anesthesiology is an ancillary service, so no consent form could waive the protection, and cost-sharing is limited to the in-network amount. The next step is a call to the provider and the plan, then the Help Desk.
Self-pay. A clinic's good faith estimate was $1,200. The bill is $1,750, which is $550 more. That's over the $400 difference CMS names, so the patient may be able to dispute, starting within 120 days of the first bill.
All amounts are made up for illustration.
Sources
- CMS: No Surprises Act key protections (rev. June 2026)
- CMS: Know your medical bill rights when not using insurance (modified Oct. 5, 2026)
Common questions
Does the No Surprises Act cover ground ambulance bills?
No. CMS says ground ambulance services are not covered by the Act, though other remedies may be available.
I signed a consent form. Did I give up my protections?
Not always. CMS says providers can never ask you to waive protections for ancillary services like anesthesiology, or for unforeseen urgent needs, and can't seek consent before you're stabilized in an emergency.
What's the deadline to dispute a bill that's higher than my estimate?
If you're uninsured or self-pay and the bill is at least $400 over the good faith estimate, CMS says you must start the dispute within 120 days of getting your initial bill.
Who do I call about a surprise bill?
Start with the provider and your plan. If that doesn't settle it, CMS lists the No Surprises Help Desk at 1-800-985-3059, and it accepts complaints online.
Does the law cover care at an out-of-network hospital I chose?
The non-emergency protection is for out-of-network providers at certain in-network facilities. Emergency care is covered wherever you go. For planned care at an out-of-network facility, check your plan's rules.
Related guides
- How to ask a hospital for financial assistance or NJ Charity Care
- How to ask your credit card company for a hardship plan
- 2027 Marketplace health insurance: estimate your cost before you pick a plan
This guide is general information, checked November 2026 against the official pages listed in Sources. It is not legal, medical, insurance or financial advice, and MCC Solutions is not affiliated with any hospital or government agency. The hospital, insurer or agency decides each case.