Surprise Medical Bills: A Practical Checklist
Surprise Medical Bills: what is worth doing, what is worth avoiding, and when to stop and see a doctor.
Unexpected bills from out-of-network providers, and the federal No Surprises Act protections that limit many of them. Since 2022, federal law protects most people from surprise bills for emergency care and for certain out-of-network care at in-network facilities.
Key takeaways
- Law: the No Surprises Act, in effect since January 1, 2022
- Emergency care: you pay no more than in-network cost-sharing, even at an out-of-network hospital
- Most useful single change: Compare any surprise bill with your Explanation of Benefits.
- Commonest mistake: Paying a balance bill you believe is protected before asking questions.
- See a doctor if any of the signs under "When to speak to a doctor" below apply to you.
Do
- Compare any surprise bill with your Explanation of Benefits
- Ask for a good faith estimate in writing if you are uninsured or paying yourself
- Read any consent form carefully before signing away your protections for planned care
- Contact the No Surprises Help Desk if you think a bill breaks the rules
Do not
- Paying a balance bill you believe is protected before asking questions
- Signing a notice and consent form under pressure without reading it
- Throwing away a good faith estimate, which you may need to dispute a bill
The numbers behind the list
The reasoning behind both lists, in numbers.
| Measure | Figure |
|---|---|
| Law | the No Surprises Act, in effect since January 1, 2022 |
| Emergency care | you pay no more than in-network cost-sharing, even at an out-of-network hospital |
| In-network facilities | out-of-network providers such as anesthesiologists or radiologists generally cannot balance bill you |
| Air ambulances | covered by the protections; ground ambulances are not |
| Uninsured or self-pay | you have the right to a good faith estimate of costs before scheduled care |
| Help line | No Surprises Help Desk, 1-800-985-3059 |
If you change one thing
Compare any surprise bill with your Explanation of Benefits. That one first, and the others when you get to them.
Related topics
- Choosing the Right Care: What Published Guidance Supports (Preventive Care)
- What the Guidance Really Says About When to Go to the ER (Using Health Services)
- The Evidence on Medicare Advantage Plans, Without the Hype (Medicare and Medicaid)
- Sexual Health Services: What Published Guidance Supports (Sexual Health)
Where to go next
- Surprise Medical Bills: Common Myths and What Guidelines Say
- Starting Out With Surprise Medical Bills
- Surprise Medical Bills — the reference entry
- Health Insurance: The Complete Guide
- Lowering Prescription Costs: What Published Guidance Supports
- Hospital Financial Assistance: Sorting the Evidence From the Noise
When to speak to a doctor
Never delay emergency care to check network status; call 911 or go to the nearest emergency room. If you receive a bill you believe is a surprise bill, contact your plan and the No Surprises Help Desk at 1-800-985-3059.
Where this comes from
How this page was put together
Every figure, recommendation and warning above is taken from the guidance named in Where this comes from. Nothing on this page is inferred, summarized or generalized beyond what those bodies publish: where they give a number, it is their number, and where they are silent, so are we. Pages are rebuilt whenever the underlying record changes. Sign-off by a named clinician, where it has happened, is shown at the top of the page along with the date.
Medical disclaimer
This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to your doctor, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 911.
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