Medical Debt Laws: What You Should Know to Protect Yourself

Did you receive a medical bill you shouldn’t owe? Do you avoid going to the doctor because you fear medical debt? Or are debt collectors harassing you, damaging your credit, or threatening legal action? If any of these scenarios apply, you may wonder if any laws provide protections against medical debt.

Federal Medical Debt Laws

The Fair Credit Reporting Act (FCRA) and Credit Bureaus

The Fair Credit Reporting Act (FCRA) regulates how consumer reporting agencies (CRAs or credit bureaus) collect, share, report, and use your credit data. The FCRA also gives you the right to access and correct information in your credit report.

Since 2022 and 2023, the three credit bureaus (Equifax, Experian, and TransUnion) have voluntarily agreed to exclude medical debts that are less than a year delinquent, paid, or under $500—even if in collections. The CRAs also agreed to remove any paid medical debt from credit reports. This gives you a year to resolve that big medical bill before it ever hits your credit report!

Since 2025, the CRAs have been voluntarily offering free credit reports once a week instead of once a year as required by the FCRA. By reviewing your credit reports, you can ensure they’re accurate and up to date. You can also look out for any signs of identity theft or medical debt that shouldn’t be on your report. Obtain a free credit report from the central source, not from the individual credit bureaus, which might require you to agree to mandatory arbitration of any dispute with the CRA. You can order them online at www.annualcreditreport.com/index.action or call 877-322-8228.

The Fair Debt Collection Practices Act (FDCPA)

The Fair Debt Collection Practices Act (FDCPA) is the law that governs debt collection practices and covers how debt can be reported in your credit report. The FDCPA also prohibits debt collection companies from using abusive, unfair, or deceptive practices to collect debts.

If you get a bill from a debt collector or see debt on your credit report that you don’t recognize, the FDCPA has a dispute process. You can learn more about how to dispute medical collections on our page, Medical Debt: Your Rights and Protections.

No Surprises Act

The No Surprises Act is a law that protects individuals against unexpected bills, particularly for emergency care and certain out-of-network charges. It covers consumers enrolled in private health insurance, such as employer-provided plans, and individual or group insurance on and off the ACA health insurance marketplaces. . 

The No Surprises Act bans:

• Surprise bills for emergency services from out-of-network providers working in an in-network facility
• Out-of-network cost-sharing for all emergency and some non-emergency services
• Out-of-network charges and balance bills for supplemental care, like radiology, anesthesiology, or lab services by out-of-network providers working in an in-network facility

Protections for Self-Pay Patients

The No Surprises Act also protects the uninsured and those choosing not to use insurance. If you received an estimate in advance and your bill is more than $400 higher than estimated, you have 120 calendar days from the date of the initial bill to dispute the charges.

Exceptions to the No Surprises Act

The No Surprises Act doesn’t pertain to ground ambulances and many urgent care centers. This law also doesn’t apply to short-term limited duration insurance, retiree-only plans, or federal healthcare programs such as Medicaid or Medicare.

Furthermore, the No Surprises Act does not regulate billing for out-of-network, non-emergency services, or items and services not covered under your health plan.

Waiving No Surprises Act Protections

Hospitals or medical providers may ask you to sign a “Notice and Consent” form to waive No Surprises Act protections. This will allow them to balance bill you for out-of-network care at an in-network facility. This is legal for certain non-emergency, planned “post-stabilization services,” when choosing an out-of-network provider. Notice and Consent forms must be accompanied by written notice that the provider is out-of-network, a cost estimate, and a statement that consent is voluntary. If no in-network provider is available to provide the needed service, a waiver cannot be used.

These waivers are not allowed for emergency care or specific ancillary services (like anesthesiology, pathology, or lab services). You can refuse to sign the waiver, especially if you didn’t have a choice of provider or facility before scheduling care. If you believe you were wrongly asked to sign a waiver that violates your rights, you can report it to the No Surprises Help Desk. 

Emergency Medical Treatment and Labor Act (EMTALA)

The Emergency Medical Treatment and Labor Act (EMTALA) is a federal law that ensures public access to hospital emergency medical care. Rights and protections under EMTALA apply regardless of your ability to pay, current medical debt, or insurance status. It requires hospitals that provide emergency services and accept Medicare to screen and “stabilize” you. Once stabilized, you are discharged — even if the underlying issue isn’t fully managed. Furthermore, EMTALA doesn’t require hospitals to provide follow-up care, which costs more.

The EMTALA does NOT:

• Mean free emergency care
• Apply to freestanding or independently operated urgent care centers
• Apply to ambulatory surgical centers, physicians’ offices, or long-term care facilities 

Section 501(r) and Extraordinary Collection Activities (ECAs)

If your medical debt is from a nonprofit hospital system, they may be required to provide information about financial assistance before initiating Extraordinary Collection Activities, or ECAs. IRS Section 501(r) is the section of the tax code that governs nonprofit hospital organizations.  Section 501(r)6 sets out requirements that nonprofit hospitals must satisfy before proceeding with ECAs.

Depending on your state’s laws, examples of ECAs can include:

• Selling medical debt to collection agencies
• Reporting medical debt to the credit bureaus, who put it on your credit report
• Filing lawsuits
• Garnishing wages
• Placing liens on property
• Seizing bank accounts
• Foreclosing on property
• Refusing or delaying medically necessary care

Requirements for Extraordinary Collections Activities

Under IRS Section 501(r)6, a nonprofit hospital generally cannot begin ECAs until: 

• At least 120 days after the first post-discharge billing statement
• Notifying you about its financial assistance policy
• Reviewing your financial assistance application when submitted during the application period (generally 240 days after the first post-discharge billing statement)
• Notifying you about ECAs used by the hospital (or other authorized party) to obtain payment
• Stating a deadline for initiating ECAs — no earlier than 30 days after the written notice

State Medical Debt Laws

Most states provide medical debt laws in addition to federal laws. One way to learn more about legal rights and protections in your state is to contact your state attorney general’s office. 

Sixteen states have banned medical debt from credit reports. However, the federal government is moving to overrule state laws that ban medical debt.

Undue Medical Debt has provided a resource titled Protect Your Credit: Keep Medical Debt Off Credit Reports. It features templates to help you contact your representative or senator and express your opposition to revoking state laws that ban medical debt from credit reports. 

How Long Can Medical Debt Remain on My Credit Report?

Most negative information can remain on your credit reports for seven years. This period generally begins 180 days after the first missed payment. Some exceptions could result in longer reporting periods. These include bankruptcies, applying for more than $150,00 in credit or life insurance, or applying for certain jobs. Additionally, if a debt collector wins a lawsuit judgment against you or your state’s statute of limitations allows it, bad credit may remain on your report longer.

When Medical Debt Laws are Violated

If you feel like your legal rights are being violated in violation of medical debt laws, you can look for answers or file a complaint.

If your health insurance company, health care provider, or health care facility violates surprise billing rules, or you have questions about the No Surprises Act, you can contact the No Surprises Help Desk at 1-800-985-3059 from 8 am to 8 pm EST, 7 days a week, or submit a complaint online. 

If you still need help with your health insurance and have a problem or question, contact your state Consumer Assistance Program. These programs help consumers experiencing problems with their health insurance or seeking to learn about health coverage options.

Help with Medical Debt

Anyone nationwide can find information about medical debt laws. You can access free legal resources and self-advocacy tools and find legal aid services at Lawhelp.org.

Another great resource from the National Consumer Law Library is the book Surviving Debt. Updated annually and available for free electronically, it contains detailed advice from consumer law experts on medical debt, dealing with debt collectors, what to do if you get sued, and more.

You can also find legal assistance by state. If you need a lawyer but don’t qualify for legal aid services, you can contact your local bar association. They can often refer you to an attorney who will give you a consultation at a reduced fee.  

Non-profit credit counseling agencies can help you create a budget and potentially negotiate a debt management plan with your creditors to lower payments or interest rates.

Medical billing advocates can help you lower, or even eliminate, high medical bills and medical debt.

Check out our blog article, How Can I Get Help with Medical Debt?

Legal Help with Medical Debt in Texas

Legal organizations also provide information about medical debt laws in your state. For example, if you live in Texas, you may visit Texas Law Help to find state-level medical debt laws and detailed guides and toolkits for Texans dealing with debt.

Key Points

• The Fair Credit Reporting Act (FCRA) regulates how debt can be reported on your credit report.
• The Fair Debt Collection Practices Act (FDCPA) regulates debt collection reporting practices.
• The No Surprises Act protects most insured individuals against some unexpected, surprise bills.
• The No Surprises Act gives those not using insurance the right to receive an estimate in advance and dispute the bill if it’s more than $400.
• IRS Section 501(r)6 limits when nonprofit hospital systems can begin Extraordinary Collection Activities.
• Relatively few states regulate billing and collections practices or limit the legal remedies available to creditors.
• The Emergency Medical Treatment and Labor Act (EMTALA) ensures public access to emergency medical services, regardless of current medical debt or insurance status.
• Most negative information can remain on your credit reports for seven years — or longer.

Frequently Asked Questions (FAQs)

What is the “No Surprises Act”?

This law protects privately insured individuals from many unexpected out-of-network or emergency bills. For those who are uninsured or not using insurance, it provides the right to a Good Faith Estimate of costs. If the final bill is more than $400 higher than that estimate, you have 120 days to dispute the charges.

What can I do if I am asked to sign a No Surprises Act Waiver?

You can refuse to sign the waiver, especially if you didn’t have a choice of provider or facility before scheduling care. If you believe you were wrongly asked to sign a waiver that violates your rights, you can report it to the No Surprises Help Desk. 

Can a medical provider send my unpaid bill to collections?

Yes, a healthcare provider is generally allowed to refer or sell an unpaid bill to a collection agency. However, non-profit hospitals may have additional requirements under Section 501(r)6 they must meet before doing so.

Can you go to the ER for free medical care?

No. This is a common misconception. The Emergency Medical Treatment and Labor Act (EMTALA) ensures access to emergency medical services to everyone, but you will most likely receive a bill. You can apply for charity care or financial assistance to reduce or sometimes eliminate the bill.

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Article by Julie Gunstanson, Certified Medical Billing Advocate, and Lauren R. Jahnke, MPAff, author of Decoding Health Insurance and the Alternatives: Options, Issues, and Tips for Saving Money.
Last update: 8-13-2026

Disclaimers and disclosures: This article provides general information about medical debt. For guidance specific to your situation, consult financial counselors, billing advocates, or legal assistance in your area. Decoding Health Care provides independent and educational information and does not endorse any specific insurance plans or other health coverage products. AI tools were used to assist in researching this article; however, human subject-matter experts always extensively revise, fact-check, edit, and approve our content.