Medical billing error
No Surprises Act Violations
Out-of-network provider billing more than in-network cost-share at an in-network facility.
Rule cited in the dispute letter: No Surprises Act — 42 U.S.C. § 300gg-111 (Pub. L. 116-260)
What the NSA protects against
Effective January 2022, the No Surprises Act prohibits balance-billing for out-of-network care provided at in-network facilities without your advance written consent. The most common scenarios it covers: an anesthesiologist who is out-of-network treating you at an in-network surgical center; a radiologist reading your in-network ER scan; a pathologist analyzing your in-network biopsy; or an emergency physician staffing an in-network ER.
How to identify a violation
Look for line items from an ancillary provider (anesthesiologist, radiologist, pathologist, ER physician, hospitalist, neonatologist, assistant surgeon) where the EOB shows "out-of-network" or the provider sends a separate bill demanding payment above the in-network cost-share. If you did not sign an NSA disclosure waiving the protection at least 72 hours before the procedure, the protection applies.
How to dispute
The dispute letter cites 42 U.S.C. § 300gg-111, identifies the provider and line items, asserts NSA protection, and asks for the charges to be reduced to in-network cost-sharing. The letter also instructs the patient to file a federal NSA complaint at 1-800-985-3059 if the facility refuses to adjust.
Frequently asked
What if I signed a form at intake?
A consent valid under the NSA must be a specific NSA notice, signed at least 72 hours in advance, and not for emergency or certain ancillary services. A generic financial-responsibility form does not waive NSA protection.
What about ground ambulance?
Ground ambulance was excluded from the initial NSA. Air ambulance is covered.
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