Can you claim?
Does this apply where you are?
US: No Surprises Act (implemented via CMS)
UK: NHS Constitution for England — complaints and redress
Your rights
No Surprises Act (implemented via CMS)
- Surprise billing protections
- Patients are protected from unexpected out-of-network bills for: "Emergency room visits"; "Non-emergency care related to a visit to an in-network hospital, hospital outpatient department, or ambulatory surgical center"; and "Air ambulance services."
- Good faith estimate
- Uninsured/self-pay patients: "providers must give you a good faith estimate of how much your health care will cost if you request one or schedule services at least 3 business days in advance."
- Dispute process
- "You may be able to dispute your bill if it's at least $400 more than the estimate."
NHS Constitution for England — complaints and redress
- NHS complaint route
- The NHS Constitution gives patients the right to have any complaint dealt with efficiently and properly investigated, and: "You have the right to take your complaint to the independent Parliamentary and Health Service Ombudsman... if you are not satisfied with the way your complaint has been dealt with by the NHS."
Evidence to gather
- Itemised bill
- Explanation of Benefits (EOB)
- Insurance policy
- Records of calls with billing
Steps
- Gather your evidence (see the list above).
- Send a written complaint to the business or provider, citing the rule for your region from "Your rights" above.
- If unresolved by their deadline, escalate using the route named in "Your rights" for your region.
- If still unresolved, consider your region's ombudsman, regulator, or small claims court — see "Your rights" for the specific option.
Your tools
Information, not legal advice. Figures verified against the official sources linked above.