I have a medical bill
Do I have to pay a doctor I never chose?
Photo: RDNE Stock project / Pexels
Maybe not in full. For emergency care, or an out-of-network doctor at an in-network hospital or surgery center, federal law usually limits you to your in-network share. Check before you pay.
What to do
- Check your bill or Explanation of Benefits (EOB), your insurer's statement of what it paid, to see if the doctor was out of network.
- Check the setting: emergency care, or care at an in-network hospital or surgery center, is usually protected.
- Check whether you signed a notice-and-consent form. Emergency doctors, anesthesiologists, radiologists, pathologists and hospitalists can't ask you to sign one.
- Ask your insurer to process the claim at your in-network share, and tell the billing office in writing that you believe it is a surprise bill.
What to say
I believe this is a surprise bill covered by the No Surprises Act. I'm asking you to bill my insurer at the in-network rate and to send me that in writing.
Say it to the doctor's billing office, and tell your insurer the same day.
What to watch out for
This is a sensitive stepSmall details here can change the outcome, and some mistakes are hard to undo. We highly recommend a free 15-minute call with us before you decide.
Paying the bill because it came from a real doctor. For protected care you usually owe only your in-network share; ground ambulance is the main gap in the federal law.
Better done together
We’re here to help
Surprise bills are confusing, and the protections only help if you use them. We help you check whether the bill is covered by the federal rules and what to say to the billing office, before you pay.
Every situation is different, and these are sensitive moments, so we look at yours with care. We often see what others miss, and we never take commissions from insurance companies: the only thing we are working for is what is right for you.
Free · 15 minutes · No pressure
The rule behind it
The No Surprises Act, a federal law in force since January 2022, covers most job-based and individual plans. It protects you from surprise out-of-network bills for emergency care, for care at an in-network hospital or surgery center, and for air ambulance; you pay only your in-network share. Ground ambulance is not covered by the federal law, though some states have their own rules.
Sources
- CMS.gov — Know your rights with insurance (No Surprises Act)
- CMS.gov — Medical bill rights and the No Surprises Help Desk
- Your Explanation of Benefits (EOB) and the doctor's bill
- Your state insurance department
Amanda Alcodia
Education, not medical, legal or insurance advice.
Useful next steps
Start with the free Kit. If your situation needs a person, the intro call is free too.