Quick Answer: Balance billing occurs when an out-of-network provider charges you the difference between their billed rate and what your insurer paid, producing an unexpected bill. The No Surprises Act bans this practice for most emergency care, ancillary services (such as anesthesiology, radiology, and pathology) provided at in-network facilities, and air ambulance. Ground ambulance remains exempt. If you get a surprise bill, contact the [medical bill analyzer](/medical-bill-analyzer) or call the No Surprises Help Desk at 1-800-985-3059.
Covered vs. Not Covered by the No Surprises Act
Understanding in-network vs. out-of-network status helps you know when the No Surprises Act applies. The law covers group and individual health plans; it does not apply to short-term plans or grandfathered plans.
No Surprises Act coverage by scenario (2026)| Scenario | Protected? |
|---|
| Emergency care at any ER | Yes |
| Ancillary services (anesthesia, radiology, pathology) at in-network facility | Yes |
| Air ambulance from out-of-network provider | Yes |
| Ground ambulance | No (state laws may apply) |
| Scheduled out-of-network care with signed consent | No |
Source: CMS No Surprises Act overview (cms.gov/nosurprises), effective January 1, 2022.
Source: https://www.cms.gov/nosurprises
Frequently Asked Questions
What does the No Surprises Act actually ban?
Since January 1, 2022, providers cannot send you a balance bill for emergency services at any ER, for ancillary care (anesthesiology, radiology, pathology, neonatology) at an in-network hospital, or for out-of-network air ambulance. You pay only your normal in-network cost-sharing (copay, coinsurance, deductible). See the full rules at [cms.gov/nosurprises](https://www.cms.gov/nosurprises).
Can I waive No Surprises Act protections?
Yes, but only for scheduled non-emergency care at an out-of-network facility, never for emergency care or ancillary services. You must receive a written notice and sign a consent form at least 72 hours before the service. If you sign, you can be balance-billed for that service.
How do I dispute a surprise balance bill in 2026?
Call the No Surprises Help Desk at 1-800-985-3059 (available 8 am to 8 pm ET, 7 days a week, with translation in 350+ languages). You can also file a complaint at cms.gov/nosurprises within 120 days of receiving the first bill. The [medical bill analyzer](/medical-bill-analyzer) can help you identify charges before you dispute.
Does balance billing protection apply to Medicare and Medicaid?
Medicare and Medicaid have separate billing-assignment rules that already limit provider charges; the No Surprises Act primarily covers private group and individual health plans. For [Medicare eligibility](/medicare-eligibility) and Medicare billing rights, your provider must accept assignment if they participate in Medicare.
