# Medical Bills Over $400 Above Estimates Now Face New Dispute Rules
Federal rules protect uninsured patients when hospitals exceed their good-faith estimates by more than $400. The No Surprises Act, which took effect January 1, 2022, requires hospitals and ambulatory surgical centers to provide written cost estimates before procedures. If the final bill runs $400 or higher above that estimate, patients have grounds to challenge the charges.
This protection applies primarily to uninsured or self-pay patients. Insured patients typically face negotiated rates through their health plans, which limits surprise bills. But for the roughly 27 million uninsured Americans, this rule creates a concrete safety net.
Here's how it works. Before a scheduled procedure, patients can request a good-faith estimate from their provider. The hospital must supply one in writing. If your final bill exceeds that estimate by $400 or more, you can dispute the charges with your provider. The hospital then has 30 days to respond and either adjust the bill or explain the difference.
The $400 threshold represents a meaningful protection without requiring perfection from providers. Medical costs shift based on complications, unexpected findings during procedures, or additional services discovered once treatment begins. The $400 buffer accounts for genuine unpredictability while preventing massive, unforeseen charges.
Patients who receive bills above their estimates should request an itemized breakdown and compare it to the original good-faith estimate line by line. Document the estimate and all communications with the provider. If the overage exceeds $400, send a written dispute citing the discrepancy.
Hospitals that violate this rule face penalties up to $300 per violation. The Department of Health and Human Services enforces these requirements.
Uninsured patients should always request good-faith estimates before elective or planned procedures. For emergencies, these protections don't apply