What to Do If You Receive a Surprise Medical Bill

Surprise medical bills happen when you receive care from an out-of-network provider — sometimes without knowing it. Federal law now provides meaningful protections. Here's what to do if you receive a bill that doesn't look right.

The No Surprises Act

As of January 2022, the No Surprises Act limits surprise billing in most situations. Key protections include:

• Emergency care at out-of-network facilities must be billed at in-network rates
• Out-of-network providers at in-network facilities (like an anesthesiologist at an in-network hospital) cannot charge more than in-network rates without your written consent
• Air ambulance services from out-of-network providers are also limited

What to Do When You Get the Bill

1. Don't pay immediately. First verify the bill against your Explanation of Benefits (EOB) from your carrier.
2. Contact your insurance carrier. Ask them to explain how the claim was processed and whether the No Surprises Act applies.
3. Contact the provider. Ask for an itemized bill and dispute any charges that appear incorrect.
4. File a complaint if needed. If you believe your No Surprises Act rights were violated, you can file a complaint at cms.gov/nosurprises.

Negotiate If Necessary

Providers often negotiate bills — especially for uninsured or underinsured patients. Ask about financial assistance programs, payment plans, or cash-pay discounts before paying any large out-of-pocket amount.

BenZen clients dealing with a confusing medical bill can reach out for guidance.