What to Do When You Get a Surprise Medical Bill

You went to an in-network hospital for a procedure. You checked. You were careful. Then, months later, a bill arrives from an anesthesiologist or assistant surgeon you never chose — and they're out-of-network. The bill is for thousands of dollars.

This is a surprise medical bill. Here's what to do.

First: don't panic, and don't pay immediately

Surprise bills are time-sensitive — but not so urgent that you should pay without investigating. You typically have 30 days or more before a bill goes to collections. Use that time to understand what happened and what your options are.

Know your rights under the No Surprises Act

The federal No Surprises Act, which took effect January 1, 2022, provides significant protection. Under this law:

• If you go to an in-network hospital or ambulatory surgery center, out-of-network providers who treat you there cannot bill you more than in-network cost-sharing rates — even if you didn't choose them
• This applies to emergency services at any facility, regardless of network
• You cannot be required to waive these protections except in very limited circumstances

Step 1: Request an itemized bill

Call the provider and request an itemized bill — a line-by-line breakdown of every charge. This is your right. Itemized bills frequently contain errors: duplicate charges, incorrect billing codes, charges for services not received. Compare it against your EOB from your insurer.

Step 2: Contact your insurance company

Call member services and ask: Was the facility in-network? Was the treating provider in-network? Does the No Surprises Act apply? What should my cost-sharing be? If the No Surprises Act applies, your insurer should be handling payment negotiation — not you.

Step 3: File a complaint if your rights were violated

If a provider is billing you more than your in-network cost-sharing in violation of the No Surprises Act, file a complaint with the CMS No Surprises Help Desk at 1-800-985-3059, or with your state insurance commissioner's office.

Step 4: Negotiate

If the No Surprises Act doesn't apply to your situation, you still have options:

• Ask for the cash-pay rate — providers often have a lower rate for patients paying directly
• Request a payment plan — hospitals are generally required to offer them
• Apply for financial assistance — nonprofit hospitals are required by law to have charity care programs
• Negotiate directly — providers frequently accept less than the billed amount

Step 5: Seek help

If you're facing a large, complex bill, contact a patient advocate. Many hospitals have patient advocates on staff. The Patient Advocate Foundation offers free case management services.

Sources: CMS — No Surprises Act, Healthcare.gov — Surprise Billing Protections