I got an out-of-network bill after an emergency room or in-network hospital visit, and my insurer did not pay. What can I do?

Health insuranceDeniedChecked Nov 5, 2026

From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-05 · Source: CMS · Know your medical bill rights · Using insurance · page last modified 10/01/2026 View original ↗

In short

A federal law protects most people with private insurance from some surprise bills.
If you used insurance, send a complaint and appeal through your plan.
The Help Desk number is 1-800-985-3059.

What this means

The No Surprises Act, in most cases, protects people with most private insurance from unexpected out-of-network bills for emergency room visits, for non-emergency care at in-network hospitals and surgery centers, and for air ambulance [1]. It generally does not cover ground ambulance (unless state law says otherwise), dental-only or vision-only plans, and some other plans [2].

If you used health insurance, you cannot use the patient-provider dispute. You can submit a complaint if you got care on or after January 1, 2022. If your insurer decided not to pay part or all of a claim and you think that breaks the law, appeal through your plan's process in its documents and denial notices [3]. You can call the Help Desk at 1-800-985-3059 for next steps [4].

Your next step

Read the denial notice for how to appeal and the date. Appeal through your plan. You can also call 1-800-985-3059. The Help Desk says it will contact you within 60 days if it needs more information.

Check it yourself

Whether your bill is one the law covers depends on the place and service: "Don't know yet". The sources do not give a deadline for the complaint; your plan's denial notice gives the appeal deadline.

Where this comes from (4)

[1] CMS · Know your medical bill rights · Using insurance · page last modified 10/01/2026 · checked 2026-11-05
In most cases, the No Surprises Act protects you from unexpected out-of-network bills from: emergency room visits; non-emergency care related to visits at in-network hospitals, hospital outpatient departments, and ambulatory surgical centers; and air ambulance services.
[2] CMS · Know your medical bill rights · Exceptions · checked 2026-11-05
Generally, ground ambulance services aren't covered by billing protections in the No Surprises Act (unless a state law has different rules).
[3] CMS · Dispute a medical bill · FAQ › What do I do if I don't qualify · checked 2026-11-05
If you used health insurance, you don’t qualify to dispute a bill. You should submit a complaint if you received care on or after January 1, 2022 … Your insurer may have decided not to pay part or all of a claim. If you think this decision violates the No Surprises Act, appeal your bill. Follow the process described in your plan’s documents and denial notices.
[4] CMS · Submit a provider or insurer complaint · What to expect · What happens next · page last modified 11/02/2026 · checked 2026-11-05
Call the Help Desk at 1-800-985-3059 to get help submitting your complaint or to find out your next steps.

How we found this

We matched your question to 4 official sources, quoted the exact lines, and re-checked each quote against its source on 2026-11-05.

What we don’t know yet

Your own plan or notice may say something different. If your letter cites another rule, send it and we will look again.

Every answer is checked against the official rule it quotes.

Information only — not legal advice. Your plan, insurer or agency decides.

This answer quotes the official sources listed above, with the date we checked them. Your own policy, notice and state rules control. We are not your lawyer or your insurer. We don’t file, argue or negotiate claims for you — you send any letter or form yourself.

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