Medical Bills: Your Rights Before You Pay (Federal and State Rules)

Before you pay a medical bill, find out which rule covers it. Federal law limits surprise out-of-network bills under the No Surprises Act, gives uninsured and self-pay patients a good faith estimate and a $400 dispute process, requires nonprofit hospitals to offer financial assistance, and gives you a right to your billing records. State laws add more protection on top, and the rules differ from state to state.

This page sorts medical bills by type and sends you to the rule, the guide and the tool for each. The detail lives in the guides; this is where to start.

Information last verified on October 20, 2026. This article has not been reviewed by a licensed lawyer.

Jurisdiction scope: This article covers federal rules on medical bills in the United States (the No Surprises Act rules in 45 CFR Part 149, the nonprofit hospital rules in 26 CFR 1.501(r), the HIPAA right of access, and Medicaid and Medicare billing protections) with examples of state laws. Each state's full rules are in the medical bill checker. It does not cover medical malpractice, workers' compensation billing or provider-insurer payment disputes.

Surprise bill check

Your state’s surprise billing and ground ambulance rules, next to the federal law.

State where you got the careChoose oneAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Federal law: for emergency care, air ambulance, and out-of-network clinicians at in-network hospitals and surgery centers, people in job-based, individual and Marketplace plans generally owe only in-network cost-sharing. Ground ambulance is not covered. No Surprises Help Desk: 1-800-985-3059.

Source: 45 CFR 149.410; CMS No Surprises Act consumer advocates toolkit

Open the full medical bill checker

What kind of bill do you have?

Find the row that matches your bill. The rule in the middle column decides what you can ask for; the guide on the right explains how.

A bill can fit more than one row. A surprise emergency bill that has already gone to a collector, for example, raises both the No Surprises Act and debt collection rules.

Before you pay: four steps for any medical bill

1. Note the date on the first bill. Several deadlines run from it, including the 120 calendar days an uninsured patient has to dispute a bill above the estimate.
2. Ask for the itemized bill and keep your paperwork. Keep your explanation of benefits (EOB) if you are insured, or your good faith estimate if you are not.
3. Call the billing office, then put it in writing. Get every promise of a correction, a discount or a pause on the bill in writing, and note the date, name and outcome of each call.
4. Check the state layer. The medical bill checker shows your state's rules on surprise bills, ambulances, charity care and medical debt, and builds a letter asking for the itemized bill.

The guide to disputing a medical bill walks through each step in order.

The federal rules, layer by layer

Surprise out-of-network bills

The No Surprises Act covers people with private health coverage, including employer plans and Marketplace plans. For emergency care, for non-emergency care from out-of-network clinicians at an in-network hospital, hospital outpatient department, critical access hospital or ambulatory surgical center, and for air ambulances, the provider "must not bill, and must not hold liable" the patient for more than the in-network cost-sharing amount (45 CFR 149.410, 149.440). Ground ambulances, doctor's offices and scheduled care at an out-of-network facility are outside it. The No Surprises Act guide explains the consent form and what to do with a bill, and balance billing laws by state shows where state law fills the gaps. The No Surprises Help Desk is 1-800-985-3059.

Uninsured and self-pay patients: the good faith estimate

If you are uninsured, or you choose not to bill your insurance, a provider must give you a good faith estimate when you schedule care at least 3 business days ahead or when you ask about cost (45 CFR 149.610). This does not include people enrolled in Medicare, Medicaid or other federal health programs: CMS says they "are not entitled to a good faith estimate even if the service they are seeking is not covered or they don't intend to use their coverage." If one provider's bill comes in at least $400 above that provider's total on the estimate, you can start the federal patient-provider dispute process within 120 calendar days of the bill, for a $25 fee (45 CFR 149.620). While the dispute is pending, the provider must not move the bill to collections, should stop collection already started, and must suspend late fees. Insured patients who use their insurance appeal through their plan instead. See the good faith estimate guide.

Nonprofit hospitals: financial assistance

Hospital organizations recognized under section 501(c)(3) must have a written financial assistance policy that covers all emergency and other medically necessary care and explains how to apply (26 CFR 1.501(r)-4). A patient eligible under the policy may not be charged more than the amounts generally billed to insured patients for that care (26 CFR 1.501(r)-5). You can apply until at least the 240th day after the first post-discharge bill, and the hospital must wait at least 120 days after that bill before extraordinary collection actions such as credit reporting, lawsuits or wage garnishment (26 CFR 1.501(r)-1, 1.501(r)-6). For-profit hospitals, and public hospitals without 501(c)(3) status, are outside this rule. The charity care guide covers state income levels and how to apply.

Your billing records

HIPAA gives you a right to inspect and get a copy of the information in a provider's designated record set, which includes "the medical records and billing records about individuals maintained by or for a covered health care provider" (45 CFR 164.501, 164.524). The provider must act within 30 days of your request, with one extension of no more than 30 days if it gives you a written statement of the reasons. How long providers must keep records is set by state law; see medical records retention laws by state.

Medicaid and Medicare

Government programs are outside the No Surprises Act but have their own protections. Medicaid providers must accept the Medicaid payment, plus any cost sharing the state plan allows, "as payment in full" (42 CFR 447.15). CMS states that "since 1997, federal law has prohibited Medicare providers from collecting Medicare Part A and Part B coinsurance, copayments, and deductibles from QMBs, including those enrolled in Medicare Advantage and other Part C plans."

Credit reports

There is no general federal ban on medical debt in credit reports. Federal law does keep a veteran's medical debt off credit reports for one year after the care, and once it is paid or settled; a veteran's medical debt here means debt owed to a non-VA provider, submitted to the VA for payment, for care the VA authorized, plus debt the VA charged wrongly (15 U.S.C. 1681a, 1681c(a)(7)-(8)). The Consumer Financial Protection Bureau's rule that would have kept most medical debt off credit reports was vacated by a federal court in Texas on July 11, 2025. Equifax, Experian and TransUnion say they leave off paid medical collections, medical collections with an initial balance under $500, and unpaid medical collections less than a year old; those are the companies' own policies, not law. For a nonprofit hospital, reporting you to a credit bureau is an extraordinary collection action subject to the 120-day wait. See medical debt on your credit report.

State laws on medical bills

The federal rules are a floor. States add their own, and they reach different bills:

• Surprise billing. In Texas, for state-regulated HMO, PPO and EPO plans, an out-of-network provider may not bill more than your copay, coinsurance and deductible for emergency care, for facility-based care at an in-network facility, or for imaging or lab work tied to care from an in-network provider (Tex. Ins. Code 1271.155, 1271.157, 1301.155, 1301.164, 1301.165). New York has a similar rule for state-regulated (fully insured) plans (N.Y. Fin. Serv. Law 603, 606).
• Ground ambulances. Colorado limits out-of-network private emergency ambulance services to your in-network cost sharing for state-regulated plans, though not ambulances run by publicly funded fire agencies (Colo. Ins. Reg. 4-2-66). California limits out-of-network ground ambulances to your in-network cost sharing for state-regulated plans issued, amended or renewed from 2024 (Cal. Health & Safety Code 1371.56).
• Charity care income levels. New York hospitals must waive all charges for uninsured or underinsured patients below 200% of the poverty guidelines (N.Y. Pub. Health Law 2807-k(9-a)). Illinois hospitals, other than rural and critical access hospitals, must give uninsured Illinois residents free care at or below 200% (210 ILCS 89/10).
• Credit reporting. California (Cal. Civ. Code 1785.27), Minnesota (Minn. Stat. 332C.03) and New York (N.Y. Pub. Health Law 4926-4927) ban medical debt reporting. These bans face a federal preemption fight: on August 10, 2026, a federal court in Austin held that the Fair Credit Reporting Act preempts a Texas provision on reporting medical debt.
• Collection limits. In Texas, a licensed health care facility such as a hospital must send a written itemized bill within 30 days after the final insurance payment and may not pursue collection until it does (Tex. Health & Safety Code 185.001-185.002). Arizona caps interest on medical debt at the lesser of 3% a year or the one-year Treasury yield (A.R.S. 44-1201(A)(1)). New York bars wage garnishment on a medical debt judgment won by a hospital or licensed health professional (N.Y. CPLR 5231(b)(iv)).

One limit applies to every state insurance law on this list: it reaches state-regulated plans, which include most individual plans and fully insured employer plans. CMS explains that for a self-insured group health plan, "a state will not be able to enforce its surprise billing protections unless the plan has opted into the state's surprise billing law." A self-funded employer plan follows the federal law.

The medical bill checker shows the full set of rules for each state, as on the Texas, New York and California pages, along with the agency that takes complaints.

Deadlines that matter

Several federal deadlines run from the first bill, so the date printed on it is worth writing down the day it arrives.

If the bill is already in collections

A bill in collections still has options. A timely financial assistance application pauses a nonprofit hospital's extraordinary collection actions until it decides, and a pending patient-provider dispute bars the provider from moving that bill to collections. Under the Fair Debt Collection Practices Act, which governs collection agencies and other debt collectors, "the collection of any amount (including any interest, fee, charge, or expense incidental to the principal obligation) unless such amount is expressly authorized by the agreement creating the debt or permitted by law" is an unfair practice (15 U.S.C. 1692f(1)).

The debt collection laws explain how to dispute a debt with a collector, the statute of limitations on debt explains when old debts become time-barred, and how to stop wage garnishment covers a court order against your paycheck. Complaints about a collector go to the Consumer Financial Protection Bureau at (855) 411-CFPB (2372).

Medical bill guides

• No Surprises Act: what it covers and how to use it
• Balance billing: state laws and the federal ban
• Good faith estimate: the $400 rule and how to dispute a bill
• How to dispute a medical bill
• Hospital charity care
• Medical debt on your credit report
• Medical bill checker

This article provides general legal information about federal and state medical billing rules in the United States as of October 20, 2026. It is not legal advice. For a specific bill, contact your health plan, the provider's billing office, the No Surprises Help Desk, your state insurance department, or a lawyer licensed in your state.

Last updated: October 20, 2026.

Frequently Asked Questions

What are my rights when I get a medical bill?

Federal law limits surprise out-of-network bills for emergency care, out-of-network clinicians at in-network hospitals and surgery centers, and air ambulances, gives uninsured patients a good faith estimate and a $400 dispute process, requires nonprofit hospitals to offer financial assistance, and gives you access to your billing records under HIPAA. Many states add more.

Should I pay a medical bill before checking it?

Check it first. Ask for the itemized bill, compare it with your EOB or good faith estimate, and note the date on the first bill, since some deadlines run from it, such as the 120-day dispute window for uninsured patients.

Can I get out of a surprise out-of-network bill?

For emergency care, out-of-network clinicians at in-network hospitals and surgery centers, and air ambulances, the No Surprises Act bars the provider from billing more than your in-network cost sharing. Ask the provider in writing to rebill, and call the No Surprises Help Desk at 1-800-985-3059 if it will not.

What if I am uninsured and the bill is higher than the estimate?

If one provider bills at least $400 more than its good faith estimate, you can start the federal patient-provider dispute process within 120 calendar days of the bill, for a $25 fee (45 CFR 149.620).

Can a hospital reduce my bill if I cannot afford it?

Nonprofit hospitals must have a financial assistance policy covering emergency and other medically necessary care, and some states set income levels for free or discounted care. The hospital decides each application under its policy and any state law.

Can medical debt go on my credit report?

There is no general federal ban; federal law covers only a veteran's medical debt for VA-authorized care from a non-VA provider, for one year after the care and once it is paid or settled. The CFPB rule that would have gone further was vacated on July 11, 2025. The three credit bureaus say they leave off paid medical collections, those under $500, and unpaid ones less than a year old, and some states ban medical debt reporting.

Who do I complain to about a medical bill?

For surprise bills, the No Surprises Help Desk (1-800-985-3059) or a CMS online complaint. For a state-regulated plan or a state rule, your state insurance department. For a debt collector, the CFPB at (855) 411-2372.