Your Healthcare Billing Rights

Since January 2022, federal law protects you from unexpected medical bills in most situations.

Emergency care: You cannot be charged out-of-network rates for emergency care, even if you go to an out-of-network hospital. Emergency rooms must treat you regardless of your ability to pay or insurance status.

Non-emergency care: If you visit an out-of-network provider at an in-network facility (like an anesthesiologist), you are protected from surprise billing. The provider must charge in-network rates or get your written consent first.

Air ambulance: Federal protections now apply to air ambulance services from out-of-network providers.

What to do if you get a surprise bill: Contact your insurer first. If not resolved, file a complaint at cms.gov/nosurprises or call 1-800-MEDICARE.

If you don't have insurance (or you're not using your insurance), you have the right to a Good Faith Estimate before you receive scheduled care.

What it covers: A written estimate of expected charges for your procedure, including items and services reasonably expected to be provided — anesthesia, lab tests, hospital fees.

How to request it: Ask your provider or facility for a Good Faith Estimate. They are required to provide one if you ask. You can ask at scheduling.

The $400 rule: If your final bill is more than $400 above the Good Faith Estimate, you can dispute it through the federal Patient-Provider Dispute Resolution process.

Deadline: Providers must give you the estimate at least 1 business day before your scheduled service.

Every nonprofit hospital in the United States is legally required under the Affordable Care Act (Section 501(r)) to:

1. Have a Financial Assistance Policy (FAP) that is publicly available on their website and available in paper form upon request. 2. Limit charges to uninsured patients to no more than the amounts generally billed to insured patients. 3. Publicize their financial assistance programs — including posting signs in ERs and billing offices. 4. Not pursue extraordinary collection actions (lawsuits, credit reporting, liens) before making a reasonable effort to determine if you qualify for assistance.

How to apply: - Ask at the billing office or patient financial services desk - Request the financial assistance application form - Submit with required documentation (tax returns, pay stubs, proof of household size) - Decisions are typically made within 30 days

Tip: Apply before you receive a bill. You can apply for retroactive assistance on bills up to 240 days old at most hospitals.

Received a bill you think is wrong or too high? You have options.

Step 1: Request an itemized bill. You have the right to an itemized statement of all charges. Review it for errors — duplicate charges, incorrect codes, and services you didn't receive are common.

Step 2: Call the billing department. Many billing errors are resolved with a single call. Ask specifically: "Can this charge be reduced?" and "Do I qualify for financial assistance?"

Step 3: Apply for financial assistance. Even after receiving a bill, you can apply retroactively. See the section above.

Step 4: Negotiate. Hospitals routinely accept less than the billed amount. Ask for a "prompt pay discount" if you can pay immediately.

Step 5: Set up a payment plan. Hospitals must offer reasonable payment plans. Federal law prohibits nonprofit hospitals from charging interest on payment plans for patients under 400% FPL.

Step 6: File a complaint. If a nonprofit hospital is pursuing collection before offering assistance, file a complaint with the IRS (Form 13909) and your state attorney general.

The Fair Debt Collection Practices Act (FDCPA) protects you even when your medical bill goes to collections.

Collectors CANNOT: - Call before 8am or after 9pm - Call your workplace if you've told them not to - Threaten violence or use obscene language - Make false statements about the debt - Threaten lawsuits they don't intend to file - Report inaccurate information to credit bureaus

Collectors MUST: - Send you a written validation notice within 5 days of first contact - Stop contacting you if you send a written cease-communication request - Tell you who they are representing

Medical debt and credit reports (new rules as of 2023): - Paid medical debt can no longer appear on credit reports - Unpaid medical debt under $500 cannot appear on credit reports - Medical debt under collection must have a 1-year waiting period before appearing on reports

Your right to dispute: You can dispute any debt in writing within 30 days of the validation notice. The collector must stop collection activities until they verify the debt.