Challenging Medical Bills: A Guide To Insurance Disputes

If you have received a surprise medical bill or a bill for emergency services and you are an insured patient, you can dispute the bill by logging onto the DFS portal to obtain a case number. If you are not using health insurance, you can also submit a complaint if your provider didn’t give you a good faith estimate.

Surprise bills

If you have received a surprise bill from a medical provider, you can dispute it with your insurance company. Here are the steps you can follow:

• Submit a complaint to the No Surprises Help Desk. Provide your email address and request a one-time PIN for security purposes.
• An independent third party will review your bill and determine an appropriate payment.
• If you and your provider or facility agree on a payment amount, the provider must reduce your bill by at least $12.50 (half of the $25 administrative fee).
• Providers or insurers submitting a dispute involving a surprise bill or bill for emergency services for an insured patient must log onto the DFS portal to obtain a case number.

If you have questions or need help, call (800) 342-3736 or email [email protected].

Not using insurance

If you did not use insurance to pay for your medical bill, you can dispute the bill by telling your provider that you did not use insurance to pay for it. You must have received a good faith estimate from your healthcare provider or facility three days before your scheduled appointment. You also need to have an initial bill that is dated within the last 120 calendar days.

You can settle the payment amount before the dispute process ends. Your provider may offer to reduce your bill, or you may agree to pay the billed amount in full. If you and your provider or facility agree on a payment amount, the provider must reduce your bill by at least $12.50 (half of the $25 administrative fee) and notify the independent third-party reviewer that you've reached a settlement.

If you received care on or after January 1, 2022, and received an out-of-network bill for a visit to the emergency room or an in-network facility, you can submit a complaint. You can also submit a complaint if you already paid more than in-network rates for a visit to the emergency room or an in-network facility.

If you haven't met your deductible, that's not a violation of the No Surprises Act. You can submit a complaint to the No Surprises Help Desk, who will review the situation and let you know about your next steps.

Out-of-network

If you have received an out-of-network bill for a visit to the emergency room or an in-network facility and you already paid more than in-network rates for a visit to the emergency room or an in-network facility, you can submit a complaint to the No Surprises Help Desk.

You can also submit a complaint if your provider didn’t give you a good faith estimate.

If you used health insurance, you don't qualify to dispute a bill.

If you got a bill and haven't met your deductible, that's not a violation of the No Surprises Act.

To learn more about surprise medical bills, visit the Health Insurance Resource Center section on Surprise Medical Bills. If you have questions or need help, call (800) 342-3736 or email [email protected].

Good faith estimate

If you have received a medical bill and haven't met your deductible, that's not a violation of the No Surprises Act. If you have received care on or after January 1, 2022, and you received an out-of-network bill for a visit to the emergency room or an in-network facility, you can submit a complaint to the No Surprises Help Desk. They will review the situation and let you know about your next steps. You will be asked to provide your email address and to request a one-time PIN for security purposes.

If you have a good faith estimate that you received from your health care provider or facility three days before your scheduled appointment, you can dispute a bill. You must have an initial bill dated within the last 120 calendar days (about 4 months).

When you dispute a bill, an independent third party will review your bill and determine an appropriate payment. You and your health care provider or facility can settle the payment amount before the dispute process ends. They may offer to reduce your bill, or you may agree to pay the billed amount in full. If you and your provider or facility agree on a payment amount, the provider must reduce your bill by at least $12.50 (half of the $25 administrative fee), and notify the independent third-party reviewer that you've reached a settlement.

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, and:

• You received an out-of-network bill for a visit to the emergency room or an in-network facility
• You already paid more than in-network rates for a visit to the emergency room or an in-network facility

No Surprises Act

The No Surprises Act is a federal law that was enacted in 2022 to protect patients from unexpected medical bills. The act prohibits health care providers from billing patients for emergency services or out-of-network care without prior notice and approval. If you receive a surprise medical bill, you have the right to dispute it with your insurance company. Here's how to do it:

First, review your bill carefully and check if it meets the criteria for a surprise bill. A surprise bill is typically one that you received for emergency services or out-of-network care without prior notice and approval. If you haven't met your deductible, that's not a violation of the No Surprises Act.

Next, submit a complaint to the No Surprises Help Desk. You can do this by visiting the CMS website and submitting your contact information. The help desk will review your situation and let you know about your next steps. They may also ask you to provide additional information or documentation to support your claim.

If you're insured, you can log onto the DFS portal to obtain a case number and submit your dispute. If it's your first time using the portal, you'll need to create an account and request access to NY IDR. Once you submit the IDR, you'll receive an IDR case number.

During the dispute process, you and your healthcare provider or facility can settle the payment amount. They may offer to reduce your bill, or you may agree to pay the billed amount in full. If you and your provider or facility agree on a payment amount, the provider must reduce your bill by at least $12.50 (half of the $25 administrative fee) and notify the independent third-party reviewer that you've reached a settlement.

Remember that the No Surprises Act protects patients from unexpected medical bills, so it's essential to review your bill carefully and submit a complaint if necessary. You can also call the No Surprises Help Desk at (800) 342-3736 or email them for assistance.

Frequently asked questions