You went to an in-network hospital for a scheduled procedure. The surgeon was in-network. But the anesthesiologist — someone you never chose — was out-of-network, and now you’re holding a bill for thousands of dollars that your insurer won’t cover.
That scenario is exactly what the No Surprises Act was designed to stop. The law took effect January 1, 2022, and it prohibits most unexpected out-of-network charges in situations where you didn’t have a meaningful choice of provider. If you received a surprise bill that may violate the Act, here’s how to report it.
This guide walks you through how to file a No Surprises Act complaint with the federal government — what qualifies, where to submit, and what happens next.
What the No Surprises Act Covers
The No Surprises Act protects patients in the following situations:
Emergency services: You cannot be billed more than in-network cost-sharing amounts for emergency care — regardless of whether the facility or providers are in-network.
Non-emergency care at in-network facilities: If you receive non-emergency care at an in-network facility but are unknowingly treated by an out-of-network provider (anesthesiologist, radiologist, assistant surgeon, hospitalist, etc.), those providers cannot bill you more than in-network cost-sharing rates.
Air ambulance services: Out-of-network air ambulance companies cannot charge more than in-network cost-sharing rates.
What it does NOT cover:
- Ground ambulance services (these have separate ongoing regulatory discussions)
- Out-of-network care you chose knowingly and signed a consent form acknowledging the potential costs
- Most care received outside of a hospital or ambulatory surgical center
- Self-pay/uninsured situations (separate good faith estimate rules apply)
Before Filing a Complaint: Key Steps
Step 1: Confirm you have a qualifying surprise bill. The bill must be for services where you didn’t have a meaningful choice of provider and didn’t sign a valid surprise billing consent form.
Step 2: Check whether you already received the correct protection. Your insurer may already be applying No Surprises Act protections — check your EOB to see if the out-of-network claim was repriced at the in-network rate.
Step 3: Contact your insurer first. Tell them the charge appears to violate the No Surprises Act and ask them to apply in-network cost-sharing. Get the representative’s name, date, and any reference number.
Step 4: Contact the provider/facility. Alert them that the charge appears to violate the No Surprises Act and ask them to reprocess the claim.
Step 5: If those steps fail, file a complaint.
How to File a No Surprises Act Complaint with CMS
The Centers for Medicare & Medicaid Services (CMS) is the primary federal agency responsible for enforcement of the No Surprises Act.
Online Complaint Portal
The fastest method is the CMS No Surprises Help Desk online complaint form:
URL: https://www.cms.gov/nosurprises/consumers/no-surprises-help-desk
This portal accepts complaints from patients, providers, and facilities.
Phone
CMS No Surprises Help Desk: 1-800-985-3059 Available: Monday–Friday, 8 a.m.–8 p.m. ET
What Information You’ll Need
When filing, have ready:
- Your name, date of birth, and contact information
- Your insurer’s name and your member ID
- The provider’s name and the facility where services were received
- Date(s) of service
- The disputed amount and explanation of why you believe it violates the No Surprises Act
- Any documentation: your EOB, the bill, any consent forms you did (or didn’t) sign
- Records of any prior communication with your insurer or provider about the bill
State-Level Complaints
Some states have additional surprise billing protections that go beyond federal law, and state insurance commissioners may have authority over certain types of plans (typically fully insured employer plans and individual/family plans, not self-funded employer plans).
To file a state complaint:
- Find your state insurance commissioner: naic.org/state_contacts
- File a complaint through the state’s online portal or consumer affairs division
- Reference both the No Surprises Act and any applicable state surprise billing law
States with stronger state-level protections (non-exhaustive):
- California (AB 72 and SB 1264)
- New York (comprehensive surprise billing law)
- Texas (SB 1264)
- Illinois
- Florida
What Happens After You File
CMS reviews complaints and may:
- Contact the insurer or provider to request information and resolution
- Investigate whether a violation occurred
- Issue civil monetary penalties for violations (up to $10,000 per violation for providers)
- Require refunds to affected patients
CMS is not a consumer advocate and doesn’t always resolve individual complaints in the patient’s favor — but filing creates a record and can trigger enforcement action, particularly for systematic violations.
Additional Resources
CMS No Surprises Help Desk
- Online: cms.gov/nosurprises
- Phone: 1-800-985-3059
U.S. Department of Labor (for federal-employee-sponsored plans)
- EBSA: 1-866-444-3272
- Online: dol.gov/agencies/ebsa
State Insurance Commissioner
- Find yours at: naic.org/state_contacts.htm
Consumer Financial Protection Bureau (for billing/collection complaints)
- Online: consumerfinance.gov/complaint
- Phone: 1-855-411-2372
Ready to Take Action?
If you’ve received a surprise bill, our free Dispute Letter Generator can help you write a formal dispute to your insurer or provider as a first step before filing a complaint. Our Complete Dispute Kit is $19 one-time. Get it →
FAQ
Q: Does the No Surprises Act apply to my employer’s health plan? A: Yes, for most employer-sponsored plans. However, it depends on whether your plan is “fully insured” (regulated by your state) or “self-funded” (regulated by federal ERISA law). Self-funded plans are still covered by the federal No Surprises Act, but state insurance commissioners may not have authority to enforce it — federal agencies do. Contact EBSA (1-866-444-3272) for self-funded plan complaints.
Q: Can I be billed more than my in-network cost-sharing for emergency care? A: No. The No Surprises Act prohibits billing you more than your in-network cost-sharing (deductible, copay, coinsurance) for emergency services — even if the emergency facility or providers are out-of-network.
Q: What if I signed a form consenting to out-of-network charges? A: It depends. Providers cannot get a valid waiver of No Surprises Act protections for emergency services or for certain non-emergency services. For non-emergency care at in-network facilities, a provider must give you a valid notice-and-consent form meeting specific federal requirements — and even then, consent is only valid for certain services and certain timing. A form buried in a stack of intake paperwork typically doesn’t satisfy these requirements.
Q: How long do I have to file a No Surprises Act complaint? A: CMSdooBenS doesn’t publish a strict deadline for complaints. However, acting promptly is advisable. Most dispute timelines (including insurance appeal windows) run from the date of the denial or bill, often measured in months.
Q: What if my state has stronger surprise billing protections? A: Apply both sets of rules. State law applies to fully insured plans regulated by the state. Federal No Surprises Act applies to most plans including self-funded employer plans. You may be able to file complaints with both your state insurance commissioner and CMS.