Surprise Medical Bill

What is a surprise medical bill?

A surprise medical bill is a charge from a healthcare provider you did not knowingly choose — or did not know was out-of-network — when you received medical care. These bills are most common after emergency room visits, surgeries performed at in-network facilities by out-of-network physicians, and air ambulance transport.

Before the No Surprises Act, surprise billing was one of the most financially devastating problems in American healthcare. Patients who chose in-network facilities and in-network surgeons routinely received five- and six-figure bills weeks later from anesthesiologists, radiologists, and emergency physicians who happened to be out-of-network — providers the patient never selected and often never knew existed until the bill arrived.

The No Surprises Act: what it means for your specific bill

The No Surprises Act, effective January 1, 2022, prohibits most forms of balance billing in three specific situations. For emergency services, providers cannot bill you more than your in-network cost-sharing amount — regardless of whether any provider involved in your emergency care is in your insurance network. This protection applies to every physician, group, or facility that billed you for emergency services.

For non-emergency care at in-network facilities, out-of-network providers cannot balance bill you unless they obtained your written consent and provided a cost estimate at least 72 hours before your appointment. Without that written consent — signed after receiving a specific required disclosure form — the balance billing is illegal. Most patients in this situation never received the required disclosures.

For air ambulance services provided by participating insurers, you cannot be charged more than your in-network cost-sharing amount for air ambulance transport, regardless of the ambulance provider's network status.

Not sure where to start? Get a free consultation — our case managers will review your situation at no cost.

The 120-day deadline: why timing matters immediately

Your right to initiate a No Surprises Act dispute through the federal Independent Dispute Resolution (IDR) process runs from the date on your Explanation of Benefits — not from the date you received care, and not from the date you received the bill. You have 120 days from your EOB date to initiate the process.

This deadline is not extended by the time you spend deciding whether to dispute, speaking with billing department representatives, or waiting to see if the bill is corrected. Every day you wait reduces the time remaining to file a formal dispute. Our case managers have seen patients lose access to the federal IDR process entirely because they waited too long after receiving their EOB.

The most common surprise billing situations

Emergency room visits account for the largest volume of surprise billing situations. You chose an in-network emergency room — but the emergency physician who treated you is employed by a staffing company that is out-of-network with your insurer. This scenario is fully covered by the No Surprises Act for emergency services received after January 1, 2022.

Surgical anesthesia is the second most common source. You scheduled surgery with an in-network surgeon at an in-network hospital. The anesthesiologist assigned that day — whom you never chose — is out-of-network. Under the No Surprises Act, they cannot balance bill you. If they did, the bill is a violation.

Post-hospitalization bills from unrecognized physician groups are increasingly common. Weeks after a hospital stay, you receive a bill from a radiology group, pathology group, or hospitalist group you've never heard of. These providers treated you during your stay — sometimes without entering your room — and may be out-of-network. Whether the No Surprises Act applies depends on whether the services were emergency or non-emergency in nature and whether the required consent process was followed.

MedErase handles this for you. Get a free consultation and our case managers will assess your specific bill.

What MedErase does when you bring us a surprise bill

Our case managers begin by obtaining your complete itemized bill and Explanation of Benefits. We verify the network status of every provider who billed you against your insurer's network directory at the time of your care — not the current directory, but the directory as it existed on the date of service. We confirm whether the No Surprises Act applies to each billing entity and to what extent.

When violations are confirmed, we file formal written disputes with the provider's billing department and simultaneously file a complaint with the HHS Office of Civil Rights. The combination of a formal billing dispute and a regulatory complaint creates immediate pressure — providers facing an HHS complaint have a strong incentive to resolve the billing dispute quickly rather than defend a regulatory investigation.

We also assess whether any portion of the bill that isn't covered by the No Surprises Act may be subject to charity care eligibility, standard billing error disputes, or direct negotiation. Our goal is the maximum available reduction across every applicable avenue.

Frequently asked questions about surprise medical bills

Does the No Surprises Act cover all out-of-network billing?

No. The No Surprises Act covers emergency services, non-emergency care at in-network facilities by out-of-network providers without the required consent process, and air ambulance. It does not cover all out-of-network care — when you knowingly choose an out-of-network provider with proper advance notice, balance billing may still be permissible.

What if I already partially paid the bill?

Partial payment does not automatically waive your No Surprises Act rights if the violation is clear. However, it does complicate your position and requires a careful assessment of exactly what was paid, when, and in what context. Our case managers assess partial-payment situations individually.

Can I dispute a surprise bill from before January 2022?

The No Surprises Act applies to services on or after January 1, 2022. For earlier surprise bills, we assess state-level balance billing protections — which existed in many states before the federal law — and negotiate using benchmark rate data and billing error documentation.