No Surprises Act
A federal law protecting patients from most surprise out-of-network medical bills, and giving uninsured or self-pay patients a way to dispute a final bill that comes in well above their Good Faith Estimate.
The No Surprises Act is a federal law that addresses a different problem than an unpaid medical bill: getting billed far more than expected in the first place, either through a surprise out-of-network charge or a final bill that blows past what you were quoted. For uninsured or self-pay patients specifically, it requires providers to issue a written Good Faith Estimate of expected charges before a scheduled service — within 1 business day if it’s booked at least 3 business days out, or within 3 business days if booked at least 10 business days out, per CMS guidance.
If the final bill comes in at least $400 more than that estimate, the patient (or their authorized representative) can start a patient-provider dispute resolution (PPDR) process within 120 calendar days of the bill date. An independent third-party dispute resolution entity then determines the amount actually owed, rather than the patient having to negotiate directly with the provider or pay the full disputed amount up front.
This is a distinct mechanism from disputing an unpaid balance already in collections — for that, see Medical Debt Escalation and Debt Validation Request. The No Surprises Act applies to the size and origin of the bill itself, not to what a hospital can do to collect on a balance you don’t dispute.
Frequently asked
Does the No Surprises Act help with a medical bill that's already in collections?
No — it addresses being billed more than expected in the first place, not what a hospital can do to collect on a balance you don't dispute. For a bill already in collections, see medical debt escalation and debt validation request instead.
— US Debt Compass Editorial Team
How much does a final bill have to exceed the estimate to qualify for a dispute?
At least $400 more than the Good Faith Estimate, and the patient has 120 calendar days from the bill date to start the dispute resolution process.
— US Debt Compass Editorial Team