Since January 1, 2022, the federal No Surprises Act protects you from most surprise out-of-network bills. In covered situations you generally owe only your in-network cost-sharing (deductible, copay, coinsurance), and the provider may not balance-bill you for the rest.
When the No Surprises Act applies
- Emergency services at any hospital or freestanding ER, in- or out-of-network.
- Non-emergency care at an in-network facility delivered by an out-of-network clinician you didn’t choose — anesthesiologists, radiologists, pathologists, ER physicians, assistant surgeons, etc.
- Air ambulance (but not ground ambulance, which is generally not covered by the federal law).
If you knowingly chose an out-of-network provider and signed a valid consent/waiver, protections may not apply — and they don’t apply if you have no insurance (use the Good Faith Estimate dispute instead).
The letter
[Your full name]
[Your address]
[City, State ZIP]
[Phone] | [Email]
[Date]
[Provider / facility billing department]
[Billing address]
Re: Surprise bill - No Surprises Act protections
Patient: [Name, date of birth]
Account / Statement number: [number]
Insurer: [plan] Member ID: [number]
Date(s) of service: [dates] Facility: [in-network facility name]
To the billing department:
I am disputing this bill under the federal No Surprises Act (effective January 1,
2022). This charge is a surprise out-of-network bill because:
[ Choose what applies: ]
- It was emergency care, which is protected regardless of network status; or
- It was care at an in-network facility provided by an out-of-network
clinician I did not choose and did not knowingly consent to.
Under the No Surprises Act I am responsible only for my in-network cost-sharing
for these services, and I should not be balance-billed for the difference. I did
not sign a valid notice-and-consent waiver of these protections.
Please:
- Reduce my balance to the in-network cost-sharing amount, and
- Work with [insurer] to resolve the remaining payment directly (the law
provides an independent dispute resolution process between you and my plan).
Please confirm in writing once my balance is corrected. I am prepared to pay the
correct in-network cost-sharing amount.
Sincerely,
[Your signature]
[Your printed name]
How to send it
Send to the provider’s billing department (and consider copying your insurer) by certified mail or secure portal, keeping copies. If the provider won’t correct it, you can report a suspected violation to the federal No Surprises Help Desk at 1-800-985-3059, and to your state insurance department.
Notes. The No Surprises Act resolves the remaining out-of-network amount between the provider and your insurer through an independent dispute resolution (IDR) process — that’s their fight, not yours; you just owe the in-network share. Ground ambulance bills are generally not covered by the federal law, though some states protect them. This is general information, not legal advice; confirm current rules at cms.gov/nosurprises.