Medical Billing Rights
Written in plain language for general understanding. This is educational content, not legal advice. Based on federal statutes and official sources.
What is this right?
The No Surprises Act, which took effect on January 1, 2022, protects you from unexpected medical bills when you receive emergency care or are treated by an out-of-network provider at an in-network facility. Before this law, patients could receive bills for thousands of dollars from doctors or hospitals they did not choose.
Under the No Surprises Act, out-of-network providers cannot bill you more than your in-network cost-sharing amount in most emergency and certain non-emergency situations. If you are uninsured or choose to self-pay, you have the right to a good faith estimate of costs before treatment. You also have the right to an itemized bill for any medical services, and you can dispute charges you believe are incorrect.
When does it apply?
This right applies when:
- You receive emergency care at any hospital or emergency room, regardless of network status
- An out-of-network doctor (such as an anesthesiologist, radiologist, or pathologist) treats you at an in-network hospital
- You are airlifted or transported by an out-of-network air ambulance
- You are uninsured or choose to self-pay and want to know costs up front
- You receive a bill you believe is incorrect or too high
Common misconceptions:
- “The No Surprises Act covers all medical bills” — It primarily covers emergency services and out-of-network providers at in-network facilities. If you knowingly choose an out-of-network provider and sign a consent notice, you may still receive higher bills.
- “I can't fight a medical bill” — You can always request an itemized bill, dispute charges, and ask for a payment plan or financial assistance.
- “If I'm uninsured, I have no billing protections” — The No Surprises Act requires providers to give uninsured patients a good faith estimate. If the final bill exceeds the estimate by $400 or more, you can dispute it through the patient-provider dispute resolution process.
What should you do?
Step 1: If you are uninsured or self-paying, ask for a good faith estimate before any scheduled service. Providers and facilities must give you an estimate of expected charges. Keep this document.
Step 2: Review every medical bill you receive. Request an itemized bill that lists each service, supply, and charge individually. Compare it with the explanation of benefits (EOB) from your insurer.
Step 3: If you receive a surprise bill for emergency care or from an out-of-network provider at an in-network facility, contact your insurer and the provider. Under the No Surprises Act, you should only owe your in-network cost-sharing amount (copay, coinsurance, or deductible).
Step 4: If the final bill exceeds your good faith estimate by $400 or more, start the patient-provider dispute resolution process at cms.gov/nosurprises or call 1-800-985-3059. You must initiate the dispute within 120 days of the bill.
Step 5: Ask about financial assistance. Nonprofit hospitals are required to have charity care programs under IRS rules (26 U.S.C. § 501(r)). Many for-profit hospitals also offer financial assistance or payment plans. Always ask for a financial counselor.
What should you NOT do?
Don't ignore medical bills. Unpaid medical bills can be sent to collections and damage your credit score. Even if you plan to dispute a bill, respond within the timeframes given.
Don't sign a waiver of your surprise billing protections unless you understand the consequences. Some out-of-network providers may ask you to sign a “notice and consent” form giving up your No Surprises Act protections. You are never required to sign this for emergency services, and for non-emergency services, you should understand that signing means you agree to pay out-of-network rates.
Don't pay a bill you believe is wrong without questioning it. Medical billing errors are common. Studies estimate that a significant percentage of medical bills contain mistakes. Always request an itemized bill and check it carefully.
Don't assume you cannot negotiate. Many providers will reduce bills, set up interest-free payment plans, or offer discounts for prompt payment. Ask before paying the full amount.
How New York differs from federal law
New York was one of the first states to pass comprehensive surprise billing protections:
- Emergency Medical Services and Surprise Bills Law (Financial Services Law § 603, effective 2015): One of the first surprise billing laws in the nation. Holds patients harmless from surprise bills by out-of-network providers at in-network facilities. Disputes between providers and insurers go through an independent dispute resolution process.
- NY's independent dispute resolution: New York's IDR process served as a model for the federal No Surprises Act. Arbitrators consider the "usual and customary" charge and other factors rather than relying solely on billed charges.
- NY Medicaid: New York has the most generous Medicaid program in the country, covering nearly 7 million residents. Covers adults up to 138% FPL with expansive benefits including dental, vision, and home care.
- NY Public Health Law § 18 (itemized billing): Patients have the right to an itemized bill that shows the specific services provided. Providers must furnish this within a reasonable time upon request.
Additional Steps in New York
File a surprise billing complaint with the NY Department of Financial Services at dfs.ny.gov or call (800) 342-3736. For Medicaid issues, contact NY Human Resources Administration or call (888) 692-6116. Contact the Community Health Advocates at communityhealthadvocates.org or call (888) 614-5400 for free billing help.
Relevant Law: NY Financial Services Law § 603 (Surprise Bill Law), NY Insurance Law § 603, NY Public Health Law § 18 (patient records and billing), NY Social Services Law § 363 et seq. (Medicaid)
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