What Should You Do If You Receive a Surprise Medical Bill?

Receiving a medical bill you were not expecting can be alarming. It may come from an out-of-network provider, an emergency visit, or a service you thought was covered. Fortunately, federal law and practical steps can help you understand and challenge the charge.

What Is a Surprise Medical Bill?

A surprise medical bill is an unexpected balance bill for services you received from an out-of-network provider or facility when you had little or no choice in the matter, such as during an emergency or when an out-of-network specialist was involved at an in-network hospital. The No Surprises Act, effective January 1, 2022, protects patients from most surprise bills in these situations.

What to Do First

1. Do not pay immediately. Take a breath and gather information. You have time to review and dispute the bill.
2. Request an itemized bill. Ask the provider or facility for a detailed list of every service, supply, and medication charged. This helps you spot duplicate charges or services you did not receive.
3. Compare with your Explanation of Benefits (EOB). Your insurer sends an EOB showing what was billed, what your plan covered, and what you may owe. If the bill does not match the EOB, question it.
4. Contact your insurance company. Ask if the provider was in-network, if prior authorization was required, and why the claim was denied or adjusted. Request a clear explanation of your financial responsibility.
5. Call the provider's billing office. Ask for a breakdown of charges and whether they can offer a discount, payment plan, or financial assistance. Many hospitals have charity care programs.

What NOT to Do

• Do not ignore the bill. Unpaid medical debt can be sent to collections and affect your credit.
• Do not pay the full amount before verifying it is correct.
• Do not assume the bill is final. Errors are common and often fixable.
• Do not provide your credit card number over the phone unless you are certain the charge is valid and you have agreed on a resolution.

Know Your Rights Under the No Surprises Act

If you received emergency care or certain non-emergency care at an in-network facility from an out-of-network provider, you are generally only responsible for your in-network cost-sharing (copay, coinsurance, deductible). The provider cannot bill you for the difference between their charge and what your insurer pays, with limited exceptions. If you believe your rights were violated, you can file a complaint with the Centers for Medicare & Medicaid Services (CMS) at 1-800-985-3059 or with your state insurance department.

When to Seek Professional Help

If the bill is large, your insurer denies your appeal, or you face collection actions, consider contacting a patient advocate, a nonprofit like the Patient Advocate Foundation, or a consumer protection attorney. Some states offer mediation programs for surprise bills.

How to Prevent Surprise Bills

Before non-emergency care, confirm that all providers and facilities are in-network. Ask for a good faith estimate if you are uninsured or paying cash. Keep records of all communications and payments. If you are uninsured, ask about self-pay discounts and charity care.

Take action quickly: review the bill, compare it with your EOB, and contact your insurer and provider. You have the right to dispute errors and to seek financial assistance. Do not let a surprise bill go unaddressed.