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Medical billing

Medical bill — surprise billing dispute

Dispute a bill from an out-of-network provider where the protections against balance billing apply.

medical.nsa-dispute8 languages30-day reply window

What it actually says.

Rendered live from invented facts: An emergency admission at an in-network hospital, billed by an out-of-network physician. The claimant is fictional and the figures are illustrative — your own claim produces its own numbers and its own citations.

The authority in the preview

It cites the article, not the act.

A document has to name the provision it relies on or it gets filed. These are the citations the sample evaluation put into the letter above; a real claim substitutes the ones its own regimes produced.
  1. 42 U.S.C. § 300gg-131No Surprises Act§ 300gg-131(a)

Where it comes from

The laws that can produce this document.

A rule module declares the documents its evaluation can render into. These are the regimes in the current catalogue that offer this one — each with its own citations, deadlines and escalation ladder.
Arizona surprise out-of-network bill dispute resolution (A.R.S. § 20-3111 et seq.)US-AZSub-national — United StatesA.R.S. § 20-3111 et seq.Confidence: mediumCalifornia surprise-billing protections (AB 72; Health & Safety Code § 1371.9)US-CASub-national — United StatesCal. Health & Safety Code § 1371.9Confidence: mediumColorado out-of-network payment and hold-harmless (C.R.S. § 10-16-704)US-COSub-national — United StatesC.R.S. § 10-16-704Confidence: mediumConnecticut surprise-bill protections (Conn. Gen. Stat. § 38a-477aa)US-CTSub-national — United StatesConn. Gen. Stat. § 38a-477aaConfidence: mediumFlorida balance-billing protections (Fla. Stat. §§ 627.64194 and 641.3154)US-FLSub-national — United StatesFla. Stat. § 627.64194Confidence: mediumGeorgia Surprise Billing Consumer Protection Act (O.C.G.A. § 33-20E-1 et seq.)US-GASub-national — United StatesO.C.G.A. § 33-20E-1 et seq.Confidence: mediumIllinois Network Adequacy and Transparency Act (215 ILCS 124)US-ILSub-national — United States215 ILCS 124/25Confidence: mediumMaine surprise-bill protections (24-A M.R.S. § 4303-E)US-MESub-national — United States24-A M.R.S. § 4303-EConfidence: mediumMaryland non-participating provider reimbursement (Md. Code, Insurance § 14-205.2)US-MDSub-national — United StatesMd. Code, Insurance § 14-205.2Confidence: lowMichigan out-of-network care provisions (Public Acts 234 and 235 of 2020)US-MISub-national — United StatesMichigan Public Acts 234 and 235 of 2020, amending the Public Health Code and the Insurance CodeConfidence: lowNew Hampshire balance-billing protectionsUS-NHSub-national — United StatesNew Hampshire insurance statutes on out-of-network and emergency care billingConfidence: lowNew Jersey Out-of-network Consumer Protection, Transparency, Cost Containment and Accountability ActUS-NJSub-national — United StatesN.J.S.A. 26:2SS-1 et seq.Confidence: mediumNew Mexico Surprise Billing Protection Act (NMSA 1978, §§ 59A-57-1 to -11)US-NMSub-national — United StatesNMSA 1978, §§ 59A-57-1 to -11Confidence: mediumNew York surprise bill protections (Financial Services Law art. 6)US-NYSub-national — United StatesN.Y. Financial Services Law art. 6, §§ 601-607Confidence: mediumOregon out-of-network provider reimbursement (ORS 743B.287)US-ORSub-national — United StatesORS 743B.287Confidence: mediumPennsylvania — federal protections and the Insurance Department routeUS-PASub-national — United StatesPennsylvania Insurance Department consumer servicesConfidence: lowTexas balance-billing prohibition (SB 1264; Insurance Code ch. 1467)US-TXSub-national — United StatesTex. Ins. Code ch. 1467Confidence: mediumNo Surprises Act (federal balance-billing protections)USNational — United StatesPHS Act § 2799A-1(a), 42 U.S.C. § 300gg-111(a)Confidence: highVirginia balance-billing protections (Va. Code § 38.2-3445.01 et seq.)US-VASub-national — United StatesVa. Code § 38.2-3445.01 et seq.Confidence: mediumWashington Balance Billing Protection Act (ch. 48.49 RCW)US-WASub-national — United StatesRCW ch. 48.49Confidence: medium

The rest of the sequence

Documents are written to be worked through in order: the opening demand, then the answer to whatever they refuse with, then the escalation. Sending the last one first usually costs you the first two.

Medical bill — request for an itemised statementAlways the first step. A summary bill cannot be checked; an itemised one frequently reveals duplicate lines, unbundled charges and services never received.medical.itemised-bill-request8 languages14-day reply windowMedical bill — bill exceeds the good faith estimateDispute a bill that came in materially above the written estimate given beforehand.medical.gfe-dispute8 languages30-day reply windowMedical bill — financial assistance applicationApply for charity care. Non-profit hospitals are obliged to have a financial assistance policy and to limit what they charge eligible patients — an obligation that is very widely under-used.medical.charity-care-request8 languages30-day reply window

You send it

Fill in your own facts and this letter writes itself.

The claim wizard produces this document with your figures, your citations and your deadline already in it. You still print it, sign it and post it yourself — that part is not delegable and we would not take it if it were.

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Duesday is not a law firm and does not provide legal advice. This document is an editable template assembled from publicly available law. You are responsible for checking that the facts and the law stated are correct for your situation, and you send it yourself in your own name. Nothing here creates a solicitor–client or attorney–client relationship, and no outcome is promised.