Emergency Room Surprise Bill? Here's How to Fight It

You went to the nearest emergency room because you had no choice. Now you are staring at a bill for thousands of dollars from an out-of-network provider. The good news: federal law now protects you from most ER surprise bills. Here is exactly how to use that protection.

Your Rights in Emergency Situations

Under the No Surprises Act (effective January 1, 2022), emergency services have the strongest protections of any healthcare scenario:

• You cannot be balance billed for emergency services, regardless of whether the facility or any treating provider is in your network
• You pay only in-network rates (your normal copay, coinsurance, and deductible), even at an out-of-network ER
• These charges count toward your in-network deductible and out-of-pocket maximum
• This applies to all emergency services including the ER facility fee, physician charges, lab work, imaging, and any stabilization treatment

Common ER Surprise Bill Scenarios

The Out-of-Network ER

You went to the nearest ER during a medical emergency. The hospital is out of your insurer's network. Under the NSA, you owe only your in-network cost-sharing amount. The ER and your insurer must negotiate the rest between themselves, or resolve it through Independent Dispute Resolution.

The In-Network ER with Out-of-Network Doctors

You went to an in-network ER, but the emergency physician, radiologist, or other specialist who treated you was out-of-network. This is one of the most common surprise bill scenarios and is fully protected under the NSA. You owe only in-network cost-sharing.

Post-Stabilization Services

After the emergency is stabilized, if you are admitted to an out-of-network facility, the NSA protections continue until you can safely be transferred to an in-network facility. The hospital cannot balance bill you for post-stabilization care unless they give you proper notice and you consent in writing to out-of-network care when a transfer is medically feasible.

Step-by-Step: Disputing an ER Surprise Bill

1. Save all documents. Keep the original bill, your insurance Explanation of Benefits (EOB), and any correspondence.
2. Contact your insurer. Call the number on your insurance card. Ask them to reprocess the claim at in-network rates under the No Surprises Act. Reference the federal law by name.
3. Contact the provider. If the billing comes from the provider (not your insurer), inform them in writing that balance billing for emergency services is prohibited under the No Surprises Act, Public Law 116-260, Division BB, Title I.
4. File a complaint with CMS. If neither the insurer nor provider corrects the bill, report the violation to CMS at 1-800-985-3059 or at cms.gov/nosurprises.
5. Contact your state insurance department. Many states have their own surprise billing laws and enforcement mechanisms that may provide additional remedies.

What If You Already Paid?

If you already paid a surprise ER bill that should have been covered at in-network rates, you can request a refund from the provider. Cite the No Surprises Act and request that the provider resubmit the claim to your insurer at the appropriate rate. If the provider refuses, file a complaint with CMS and your state insurance department. You may also have a private right of action under some state surprise billing laws.