Unexpected medical bills, often called “surprise bills,” can be a major source of financial stress for American families. These bills typically occur when you receive emergency care or are treated by an out-of-network provider at an in-network facility without your knowledge or consent.

The No Surprises Act, which took effect in 2022, was designed to protect consumers from these situations by limiting the amount you can be charged for certain out-of-network services. If you believe you’ve been wrongly billed, understanding your rights and knowing how to file a complaint is the first step toward resolution.

What Is a ‘Surprise’ Medical Bill?

A surprise medical bill is a bill for the difference between what your health plan pays and the provider’s total charge. This is also known as “balance billing.” The No Surprises Act prohibits this practice in specific circumstances, including:

  • Most emergency services, even if the hospital or provider is out-of-network.
  • Certain non-emergency services from out-of-network providers at an in-network hospital or ambulatory surgical center, such as an anesthesiologist or radiologist.
  • Air ambulance services.

Step-by-Step: How to File a Complaint

If you receive a bill you believe violates the No Surprises Act, you can file a complaint with the federal government or your state’s insurance commissioner. The primary federal resource is the No Surprises Help Desk, managed by the Centers for Medicare & Medicaid Services (CMS).

Before you begin, gather the following information and documents:

  • Your medical bill and any other correspondence from the provider or facility.
  • Your health insurance card.
  • Your Explanation of Benefits (EOB) from your health plan.
  • A copy of any good faith estimate you received.

You can contact the help desk in two ways:

  • By Phone: Call 1-800-985-3059. The help desk can assist you with questions and help you submit a complaint.
  • Online: Use the online Consumer Complaint Form at CMS.gov.

What Happens After You File Your Complaint?

Once you submit your complaint, the No Surprises Help Desk will review the information. They may:

  • Review your complaint to ensure the provider or insurer followed the surprise billing rules.
  • Investigate compliance with federal law.
  • Refer your complaint to the appropriate state or federal agency, if necessary.

You will receive a confirmation number. You can use this to follow up on the status of your complaint. It’s important to note that during this process, a provider or facility cannot send the bill to collections or charge late fees.

Additional Resources and Tips

Navigating the healthcare system can be complex, but you don’t have to do it alone. If you’ve been unfairly charged, you can also consider these additional steps:

  • Contact the provider: Explain that you believe you have been wrongly billed under the No Surprises Act.
  • Dispute the bill: Ask for an itemized bill to check for any inaccuracies.
  • Engage your employer: If you have health insurance through your job, your Human Resources department can advocate on your behalf.

For more information on your rights, visit the official CMS website at CMS.gov.