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Surprise medical bill: your rights and what to do
The No Surprises Act
The No Surprises Act protects many people from unexpected out-of-network bills. If you think you were billed wrongly, you can dispute it and file a complaint.
What is protected
- Emergency care.
- Non-emergency care from out-of-network providers at an in-network hospital, outpatient department or surgical center.
- Air ambulance services.
Ground ambulance services are not covered by these protections.
What to do
- Do not pay right away. Ask the provider for an itemized bill and your insurer for the EOB.
- Compare them. Check whether the bill is for a protected service and whether you were charged more than your in-network share.
- Dispute in writing. Send the provider and the insurer a letter that explains the problem and cites the law.
- File a complaint if needed. You can submit a complaint through CMS. The No Surprises Help Desk is 1-800-985-3059, open 7 days a week.
If you have no insurance, or you pay yourself
Providers generally must give a good faith estimate when you ask for one or schedule care at least 3 business days ahead. You may be able to dispute a bill that is $400 or more over that estimate.
Want help writing your letter?Upload your denial letter, explanation of benefits or bill to MyMedReply. It writes your appeal or dispute and cites the rules that usually apply. The draft is free; you pay only to copy it.
Write my appeal
Sources
This guide is general information, not medical, legal or insurance advice. Rules and deadlines vary by plan and state, so your denial letter and plan documents control. Medicare and Medicaid have their own appeal rules.