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Surprise medical bill: what to do

A surprise bill is an unexpected balance bill for out-of-network care you did not choose, like an emergency or an out-of-network doctor at an in-network hospital. A federal law called the No Surprises Act limits these in many cases. Here is what it covers and what to do.

What counts as a surprise bill

Surprise billing is a type of balance billing, where a provider bills you for the part of a bill your plan does not cover. It often happens when you could not pick an in-network provider, such as during an emergencysource.

What the No Surprises Act protects

The No Surprises Act protects people with most group and individual health coverage from surprise bills for most emergency services, for many out-of-network services delivered at an in-network facility, and for out-of-network air ambulance servicessource. These protections apply for plan years beginning on or after January 1, 2022source.

When it may not apply

The protections generally do not apply to ground ambulance services, to care at an out-of-network facility, or where a provider was allowed to give you notice and you signed a consent to waive the protectionssource. Read anything you are asked to sign before care carefully.

What to do

Do not rush to pay a surprise bill you have not checked. Compare it to your Explanation of Benefits (see how to read an EOB), and if it looks like a surprise out-of-network charge, contact the No Surprises Help Desk at 1-800-985-3059 or file onlinesource. If your plan denies a claim, you can generally request an internal appeal, and plans must give you at least 180 days to file it and then decide the appeal within 60 dayssource.

Frequently asked questions

Who do I call about a surprise medical bill?

The No Surprises Help Desk at 1-800-985-3059, or file a complaint onlinesource.

When did these protections start?

They apply for plan years beginning on or after January 1, 2022source.

Does the law cover ground ambulances?

Generally no. Ground ambulance services are not covered by the surprise-billing protectionssource.

How long do I have to appeal a denied claim?

Plans must give you at least 180 days to file an internal appeal, then decide it within 60 dayssource. Confirm your plan deadlines.

Sources

Important

This guide is general information, not legal advice. Federal rights have conditions and exceptions, and laws change. Confirm anything important at the primary government source linked on this page, or with your own counsel.