Uninsured and Hit With a Surprise Bill? Your No Surprises Act Rights

Most people think the No Surprises Act only protects people with health insurance. But uninsured and self-pay patients have their own set of protections under this landmark 2022 law — including the right to a good faith cost estimate before scheduled care and the right to dispute bills that exceed that estimate by a significant margin.

If you are uninsured or chose to pay out of pocket, here is what the law gives you.

The No Surprises Act for Uninsured Patients

When the No Surprises Act (NSA) took effect in January 2022, one of its most important provisions for uninsured patients was largely overlooked: the Good Faith Estimate (GFE) requirement.

Under the NSA, providers and facilities that schedule care for uninsured or self-pay patients must provide a written good faith estimate of expected charges at least 3 business days before the service if the service is scheduled at least 10 days in advance. If scheduled 3–9 days in advance, the GFE is due at least 1 business day before.

The GFE must include:

• The expected primary service charge
• Charges for any reasonably expected ancillary services (anesthesiology, labs, pathology, etc.)
• Itemized list of items and services

Providers cannot waive this requirement or provide vague estimates. If you ask for a GFE and don't receive one, that is a violation you can report to CMS.

The Patient-Provider Dispute Resolution Process

If the bill you receive is at least $400 more than the good faith estimate for the same provider/facility, you have the right to use the Patient-Provider Dispute Resolution (PPDR) process administered by CMS.

The PPDR process works as follows:

1. You initiate a dispute by submitting a request to a CMS-approved dispute resolution entity within 120 days of receiving the bill
2. Submit your GFE and the actual bill showing the discrepancy
3. The dispute entity reviews both documents and considers what a reasonable charge would be
4. A binding determination is issued: Either you pay the billed amount or a lower amount, depending on the entity's finding

The filing fee is currently $25 (refunded if you win). There is no need for an attorney.

Surprise Bills for Emergency Care (Insured and Uninsured)

For emergency care, the NSA provides strong protections even for situations involving insurance:

• Providers cannot bill patients more than their in-network cost-sharing for emergency services, regardless of whether the provider is in-network
• This applies at emergency facilities and applies to ancillary providers at those facilities
• Balance billing (billing the patient for the difference between the provider's charge and insurance payment) is prohibited for surprise bills

Important caveat: Ground ambulance services are currently largely excluded from NSA protections, though federal rulemaking is ongoing. If you received a surprise ground ambulance bill, check whether your state has separate balance billing protections.

Charity Care and Financial Assistance Programs

If you are uninsured and cannot afford your medical bills, separately from the NSA:

• 501(c)(3) nonprofit hospitals are required to have written financial assistance policies and provide free or discounted care to patients below certain income thresholds (typically 200–400% FPL)
• Hospitals must publicize their financial assistance policies, provide plain-language summaries, and make applications available
• If a nonprofit hospital did not inform you of financial assistance eligibility before sending the bill to collections, that may violate federal requirements and state laws

Before paying any large medical bill, ask the hospital's billing department for a financial assistance application and ask whether your bill qualifies for charity care. Many hospitals will also negotiate self-pay discounts — often significantly below the billed charge.

Medical Debt Protections

Federal and state laws protect consumers from aggressive medical debt collection:

• The Fair Debt Collection Practices Act (FDCPA) prohibits abusive collection practices, including calling at unreasonable hours, making false statements, and threatening action the collector cannot take
• Medical debt under $500 no longer appears on major credit reports (a 2024 change by CFPB and the three major bureaus)
• Several states have enacted laws limiting medical debt collection and credit reporting

What to Do If You Receive a Surprise Bill

1. Request an itemized bill: You have the right to a complete, itemized bill. Billing errors are extremely common — review every line item.
2. Compare to your GFE: If the bill exceeds the GFE by $400 or more, you can use the PPDR process.
3. Apply for financial assistance: Do this before paying anything, especially at nonprofit hospitals.
4. Negotiate: Medical bills are often negotiable. Ask for a self-pay or prompt-pay discount.
5. Dispute billing errors: If items are incorrect, dispute them in writing.
6. File a complaint with CMS: If you did not receive a required GFE, report the violation at cms.gov/no-surprises.

Fight Back With ClaimBack

Surprise medical bills are a financial crisis for millions of uninsured Americans. ClaimBack helps you understand what you legally owe, dispute improper bills, and access the protections the law provides.

Start your dispute at ClaimBack

Related Reading

• How to Write an Insurance Appeal Letter
• What Is Medical Necessity?
• Common Reasons Insurance Claims Are Denied