Got a surprise medical bill? Here's the timeline.
An 8-axis decoder that routes a confused patient to the correct dispute path: Federal IDR, PPDR self-pay, state DOI, DOL/EBSA, or the free CMS NSA complaint pathway. Statute-pinned. Your inputs never leave your browser.
- Statute-pinned to 45 CFR Part 149
- Client-side — inputs never leave your browser
- Primary CMS / HHS / state DOI sources
The CMS-administered consumer complaint pathway. Free, federal, and the recommended first action for any balance-billed insured patient. You have 90 calendar days from when you knew or should have known of the NSA violation to file.
- Effective 2022-01-01
- 30 business-day open negotiation
- 4 business-day IDR initiation
- $400 GFE / PPDR threshold
- 90-day NSA complaint window
- Ground ambulance: state law controls
How the decoder routes you
The five questions that decide everything
NSA dispute-path decoder
8-axis decision tree. Answer the questions; the engine routes you to the correct dispute path and procedural clock. Your inputs never leave your browser.
Quick reference
Payer × service-type routing
Educational pillars
Walk through the law, end-to-end
Six statute-pinned explainers covering every branch the decoder can route you to — from emergency-care protection to ERISA preemption.
What the No Surprises Act protects
Federal patient protection against balance-billing for emergency, OON ancillary at INN facilities, and air-ambulance services. Effective 2022-01-01. (PHSA §2799A-1)
Am I eligible for IDR or PPDR?
Eligibility decision tree by service type × payer type × state × INN-OON × notice-consent. Patient files NSA complaint; provider/plan run Federal IDR. (45 CFR Part 149 Subpart E)
Self-pay GFE dispute — PPDR pathway
Uninsured/self-pay patients whose bill exceeds the good-faith estimate by $400+ can file PPDR. 120-day filing window, $25 administrative fee. (45 CFR §149.620)
The 30-day open-negotiation clock
Provider and plan have 30 business days to negotiate after the EOB. If they don't agree, the provider has 4 business days to initiate Federal IDR. (45 CFR §149.510)
Ground ambulance — NSA does NOT cover
Federal NSA excludes ground ambulance. ~10-15 states have their own balance-billing laws (NY, CO, MD, ME, VT). The 50-state matrix below shows each. (PHSA §2799A-1(a))
ERISA vs non-ERISA — who has jurisdiction?
Self-funded ERISA plans are NOT subject to state DOI jurisdiction (federal preemption). DOL/EBSA enforces; CMS handles NSA complaints. (29 U.S.C. §1144)
50-state ground-ambulance balance-billing map
NSA does NOT cover ground ambulance. State law controls.
Click any state for its ground-ambulance statute (where one is in force), the state DOI consumer-protection entry point, and the state's relationship to ERISA self-funded plans.
Frequently asked
Frequently asked about the No Surprises Act
Start here
Decode your dispute path in under two minutes
Answer eight questions about your bill. The decoder routes you to Federal IDR, PPDR self-pay, state DOI, DOL/EBSA, or the free CMS complaint pathway — every verdict reproducible from 45 CFR Part 149.
Informational, not legal, medical, or insurance advice. The free CMS No Surprises Help Desk is 1-800-985-3059.