Dispute a Surprise Medical Bill (No Surprises Act)
If you got hit with a surprise bill from an out-of-network provider during an emergency, at an in-network hospital, or from an air ambulance, the federal No Surprises Act likely protects you. You cannot be balance-billed beyond your in-network cost-sharing in these situations. If you're uninsured or self-pay, you're also entitled to a Good Faith Estimate, and you can dispute a bill that exceeds it by $400 or more.
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The federal No Surprises Act (effective January 1, 2022) protects you from 'balance billing' (surprise bills) in three main situations: emergency services from an out-of-network provider or facility; non-emergency services by out-of-network providers at an in-network facility (such as anesthesiologists, radiologists, or assistant surgeons you did not choose); and air-ambulance services from out-of-network providers. In these cases you only owe your normal in-network cost-sharing (copay, coinsurance, deductible), and the provider must resolve the rest with your health plan. If you are uninsured or self-pay, providers must give you a Good Faith Estimate of expected charges; if your final bill is at least $400 more than that estimate, you can use the federal Patient-Provider Dispute Resolution process. To report a violation, you can contact the federal No Surprises Help Desk at 1-800-985-3059. These are federal protections; some states have additional surprise-billing laws.
Step by step
- 1Identify whether the bill qualifies: was it emergency care, care at an in-network facility from an out-of-network provider you did not choose, or air ambulance? If so, balance billing is prohibited. If you are uninsured/self-pay, locate your Good Faith Estimate.
- 2Request an itemized bill from the provider and compare it to your Explanation of Benefits (EOB) from your insurer, or to your Good Faith Estimate if you are self-pay. Flag any amount above your in-network cost-sharing or more than $400 above the estimate.
- 3Send a written dispute to the provider (use the prefill below) stating that the No Surprises Act applies and that you only owe in-network cost-sharing. Ask them to rebill your insurer and correct your balance.
- 4If unresolved, call the federal No Surprises Help Desk at 1-800-985-3059 to file a complaint, or, if you are self-pay and the bill exceeds your Good Faith Estimate by $400+, initiate the Patient-Provider Dispute Resolution process through CMS.
What they'll say, and your comeback
“The provider was out of network, so you owe the full balance.”
Comeback, Under the federal No Surprises Act, I cannot be balance-billed for out-of-network care in an emergency, at an in-network facility by a provider I did not choose, or for air ambulance services. I owe only my in-network cost-sharing. Please rebill my insurer and correct my balance.
“You signed a consent form agreeing to out-of-network charges.”
Comeback, The No Surprises Act's consent waiver does not apply to emergency services, nor to ancillary providers like anesthesiology, radiology, or pathology. A consent form cannot override these protections. Please correct the bill.
“This Good Faith Estimate was just an approximation.”
Comeback, As a self-pay patient, I am entitled to dispute a bill that exceeds my Good Faith Estimate by $400 or more through the federal Patient-Provider Dispute Resolution process. Please reduce the charge to the estimate or I will initiate that process.
FAQ
Does the No Surprises Act apply if I have insurance through my employer?
Yes. The protections apply to most job-based and individual health plans, as well as to uninsured and self-pay patients through the Good Faith Estimate process. It covers emergency care, certain out-of-network providers at in-network facilities, and air ambulances.
What if I already paid the surprise bill?
You can still dispute it and request a refund of any amount you paid above your in-network cost-sharing. Send a written dispute citing the No Surprises Act, and if the provider refuses, file a complaint with the federal No Surprises Help Desk at 1-800-985-3059.
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A self-serve tool, not a law firm. General information, not legal advice.