Does the No Surprises Act apply to ground ambulances?

No. Ground ambulance services are currently exempt from the No Surprises Act. However, some states have their own laws protecting patients from surprise ground ambulance bills.

What is a Good Faith Estimate?

A Good Faith Estimate is a written estimate of expected charges that healthcare providers must give uninsured or self-pay patients before scheduled services. If the actual bill exceeds the estimate by $400 or more, you can dispute it.

The No Surprises Act: What Patients Need to Know in 2026

What Is the No Surprises Act?

The No Surprises Act (NSA) is a federal law that took effect January 1, 2022. It protects patients from surprise medical bills when they receive emergency care, are treated by out-of-network providers at in-network facilities, or receive air ambulance services from out-of-network providers. Under the NSA, you only owe your in-network cost-sharing amount (copay, coinsurance, or deductible) in these situations — the provider and insurer must resolve the payment dispute between themselves.

When Does the No Surprises Act Apply?

The NSA applies in three main scenarios: (1) Emergency services at any facility, regardless of network status. (2) Non-emergency services at an in-network facility by an out-of-network provider you did not choose (such as an anesthesiologist, radiologist, or assistant surgeon). (3) Air ambulance services from out-of-network providers. The law applies to most private insurance plans, including employer-sponsored plans and marketplace plans. It does not apply to Medicare, Medicaid, TRICARE, or VA benefits, which have their own protections.

Your Right to a Good Faith Estimate

If you are uninsured or self-pay, the NSA requires providers to give you a Good Faith Estimate (GFE) of expected charges before scheduled services. If the final bill exceeds the GFE by $400 or more, you can dispute the bill through a federal patient-provider dispute resolution process. Request a GFE in writing for any planned procedure.

How to File a No Surprises Act Complaint

If you receive a surprise bill that violates the NSA, you can file a complaint with CMS (Centers for Medicare & Medicaid Services) at 1-800-985-3059 or through the CMS No Surprises Help Desk. You can also file complaints with your state insurance department. Keep copies of all bills, EOBs, and communications.

Limitations of the No Surprises Act

The NSA does not cover ground ambulance services (a significant gap that Congress is working to address). It also does not apply if you voluntarily consent to out-of-network care in advance by signing a written notice and consent form. Post-stabilization services — care after you are stabilized in an emergency — are covered only if you did not consent to out-of-network care.