No Surprises Act Disputer

Surprise bills from out-of-network providers at in-network facilities are restricted in many situations under federal law. This tool helps you determine whether the No Surprises Act may apply and produces a dispute notice with appropriate regulatory framing.

What you get

A plain-English read on whether your situation may qualify for protections
A dispute notice draft you can send to the right party
Context on in-network facility and emergency scenarios
Clear language you can use when following up by phone or portal

Who this is for

Anyone who received a balance bill after an emergency visit, surgery, or imaging at a hospital they believed was in network.

Common situations this tool handles

You had surgery at an in-network hospital and received a separate bill from an out-of-network anesthesiologist you never chose.
Your child was treated in an in-network emergency room and you received a bill from an out-of-network radiologist who read the X-ray.
You scheduled a procedure at an in-network facility and signed a consent form with a balance billing waiver you did not notice.

What your analysis looks like

Sample analysis for illustration. Your output will reflect your specific document and situation.

NO SURPRISES ACT REVIEW

Situation: Out-of-network anesthesiology bill following in-network surgery Facility: In-network hospital Service date: [Date]

INITIAL ASSESSMENT

This situation appears to fall within the scope of the No Surprises Act protections. Under the Act, patients who receive care at in-network facilities are generally protected from surprise bills from out-of-network providers who were not chosen by the patient. Anesthesiology is one of the most common categories covered by this protection.

Key conditions that appear to be met based on your description:

The facility was in-network with your plan
The out-of-network provider was not selected by you
The service was not a scheduled procedure where advance notice and consent were provided in writing

IMPORTANT CAVEAT

This analysis is based on the information you provided. You should verify that your plan is subject to the No Surprises Act (most employer and marketplace plans are; grandfathered plans and some self-funded plans may differ). Short-term health plans are not covered.

DISPUTE NOTICE DRAFT

The following notice is addressed to the out-of-network provider and copied to your insurer. It references 45 CFR Part 149 and requests that the claim be processed at the in-network rate... [Full dispute notice follows...]

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Questions about this tool

Does the No Surprises Act cover all surprise bills?

No. It covers specific situations: emergency care, and non-emergency care at in-network facilities by out-of-network providers you did not choose. It does not cover all out-of-network situations.

What if I signed a consent form to be billed out-of-network?

Consent to balance billing is only valid in specific circumstances and must be given voluntarily with advance notice. Emergency care cannot be waived at all. Bill Advantage can help you evaluate whether a consent form you signed was valid.

How do I file a complaint if the provider will not honor my dispute?

You can file a complaint with the No Surprises Help Desk at 1-800-985-3059 or online at cms.gov. Bill Advantage can help you draft that complaint as well.

What is new in 2026

No Surprises Act IDR Process in 2026

The independent dispute resolution process continues to expand in 2026 with a focus on fixing process gaming by high-volume filers. If your dispute involves a facility bill from late 2025 or 2026, verify the current IDR portal status at cms.gov before submitting.

These are general updates only. Your specific analysis always uses the latest rules for your document.

How it works

Upload your document. Photo or PDF of your medical bill, EOB, denial letter, or COBRA notice. No account needed to start.
We review it. Bill Advantage reviews your document against healthcare billing rules, insurance regulations, and common error patterns, reflecting the knowledge of healthcare billing professionals, encoded into a system that works in minutes, not days.
You get answers. Receive a plain-English explanation of exactly what happened and why. For most tools, a ready-to-send dispute or appeal letter is included. Save results to your Healthcare Finance Tracker, set reminders for follow-up deadlines, and build a complete record of your healthcare finances over time.

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