The No Surprises Act and Stroke Care: What You Need to Know
How federal balance-billing protections apply to emergency stroke care, air ambulance and out-of-network clinicians at in-network facilities.
March 22, 2026 · 5 min read · StrokeBill Team
A short history
The federal No Surprises Act took effect in 2022 and protects patients from most surprise out-of-network bills for emergency services, air ambulance transport and certain non-emergency services performed by out-of-network clinicians at in-network facilities.
How it applies to stroke care
Stroke patients almost always arrive through emergency departments. Under the Act, the emergency department visit itself and the stabilizing care that follows must be billed at the in-network rate even if the hospital or treating clinician is technically out of network.
What is not covered
Ground ambulance is not protected by the federal Act, though many states have stepped in with their own protections. Inpatient rehabilitation transfers also fall outside the Act once the patient is stabilized.
How to dispute a surprise bill
If you receive a bill that you believe violates the Act, file a Patient-Provider Dispute Resolution request through the CMS portal within 120 days of the initial bill date. Keep every version of the bill and every EOB.
Why this matters
Stroke care averages five figures even for short hospitalizations. The federal protections in the Act are one of the strongest tools available to stroke survivors and families.
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