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No Surprises Act Calculator

Find out if a surprise bill or a bill above your good faith estimate breaks federal law, what you should owe, and your deadline to dispute it.

Your situation

Good faith estimate from this provider ($)

Bill from the same provider ($)

Date on the first billCheck each provider or facility on the estimate on its own.

Who the No Surprises Act Protects

Situation	Protected?	What you pay
Emergency care, in or out of network	Yes	Your in-network share
Out-of-network doctor or lab at an in-network hospital or surgery center	Yes, with narrow exceptions	Your in-network share
Air ambulance	Yes	Your in-network share
Ground ambulance	No (state laws may help)	Whatever your plan and state allow
Out-of-network office or facility you chose	No	The out-of-network bill
No insurance, or not using it	Yes: good faith estimate rights	Dispute if the bill is $400 or more over the estimate

If You Have Insurance

For protected care, the provider can bill you only your in-network deductible, copay or coinsurance. Your plan and the provider settle the rest between them. Many plans base your share on the qualifying payment amount, which is usually lower than the full bill.

Some providers ask you to sign a notice and consent form to give up these protections. That is only allowed for certain scheduled care, with the form given at least 72 hours ahead. It can never be used for emergency care, anesthesia, radiology, pathology, lab work, neonatology, assistant surgeons, hospitalists or intensivists.

If You Do Not Use Insurance

Ask for a good faith estimate when you schedule. Keep a copy.
Compare the bill with the estimate for each provider or facility.
If one is $400 or more over, start a dispute at cms.gov within 120 days of the bill date.
Pay the $25 fee and send copies of the estimate and the bill.
Wait for the decision. The provider cannot send the bill to collections in the meantime.

Not eligible for a dispute? You can still lower the bill. Read how to dispute a medical bill, or use our bill negotiation letter generator. For the full rules, see our No Surprises Act guide.

Sources: CMS, Medical Bill Rights: Dispute a Bill and Know Your Rights pages; 45 CFR 149.410, 149.420 and 149.430 (surprise billing protections); 45 CFR 149.610 and 149.620 (good faith estimates and patient-provider dispute resolution). Checked November 9, 2026.

Frequently Asked Questions

What is the No Surprises Act?

A federal law, in effect since 2022, that protects patients from most surprise out-of-network bills. Insured patients pay only their in-network share for emergency care, for out-of-network doctors at in-network hospitals and surgery centers, and for air ambulances. Patients without insurance get a good faith estimate and can dispute a bill that is $400 or more over it.

How much over the good faith estimate can a bill be?

If a provider or facility bills $400 or more above its own good faith estimate, you can start the federal patient-provider dispute process. The $400 test applies to each provider or facility on the estimate, not to the total.

How long do I have to dispute a bill?

120 calendar days from the date on the first bill. The fee is $25, and it comes off what you owe if the reviewer sides with you.

When must a provider give a good faith estimate?

If you do not use insurance, you get one when you schedule care at least 3 business days ahead, or when you ask. It is due within 1 business day if you schedule 3 to 9 business days ahead, and within 3 business days if you schedule 10 or more business days ahead or ask for one.

Does the No Surprises Act cover ground ambulances?

No. Ground ambulance bills are not covered by the federal law yet. Many states have their own protections, so check with your state insurance department.

Can a provider send my bill to collections during a dispute?

No. While the dispute is open, the provider or facility cannot send the bill to collections, threaten to, or charge late fees on it. If it is already in collections, they must stop until the dispute ends.

Hassan Raza Awan, Founder of LegitMedBilling & IT Solutions

Written by Hassan Raza Awan

Founder — LegitMedBilling & IT Solutions

Hassan has 4+ years of hands-on U.S. medical billing experience — working claims, denials, credentialing, and payer follow-up for practices across the United States. Every guide he publishes is written from real remittances and payer behavior, not theory.

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