Your situation: Unexpected bill for emergency room visit

This action plan applies to you if: 

• You went to the emergency room and got a medical bill from your visit that you weren’t expecting
• You used health insurance (Marketplace, employer-sponsored, or another private health plan)

 

Not your situation?

Answer a few questions, and we’ll get you to the right place.

Get a different action plan for your bill

 

Action Plan

Learn about your rights.

When you get emergency room care, you have federal protections under the No Surprises Act in most cases. (This applies to most types of health insurance.) You only have to pay your copay or coinsurance and deductible. 

Get more information about your rights

Protections from unexpected out-of-network bills don't apply when you get: 

• Ground ambulance services
• Vision care, using limited scope vision insurance
• Dental care, using limited scope dental insurance
• Short-term limited duration and health care sharing ministry plans
• Fixed indemnity expected benefits plans, like travel or hospital indemnity insurance

If this applies to you, read about getting help from outside resources.

Check your bill for errors.

Does your bill match what happened when you got care? Are you getting billed twice for the same thing or for services you didn’t get? 

Learn how to check your bill

Compare the explanation of benefits from your health plan to your bill.

Look at the “What you owe” column in the explanation of benefits. It should be the same as the amount on your bill.

Learn how to read your explanation of benefits

Talk to your provider if your bill is more than your explanation of benefits.

Ask your provider or health care facility to reduce your bill or give you a refund if you already paid.

Talk to your health insurance company if you were billed for a service you thought was covered by the health plan.

If you can't come to an agreement with your provider or health insurance company, submit a complaint.

When you submit a complaint, you're still responsible for paying the amount listed as "What you owe" in your explanation of benefits.  But submitting a complaint will help us ensure that providers follow the explanation of benefits in the future.

Learn how to submit a complaint

Get help from outside resources.

Here are more resources to help resolve your issue:

Consumer Assistance Programs

Consumer Assistance Programs may be able to give you advice for your specific case in the state you got care. 

Find a Consumer Assistance Program in your state on CMS.gov

Patient advocates

Patient advocates can handle medical billing issues on your behalf.  

Find out how patient advocates can help you

Friends and family

Consider asking a loved one for help. They can advocate on your behalf if you're feeling sick or overwhelmed.