Phone script: first call to the billing office about a surprise bill

Date and time of this call: [Date and time of this call] Before you call, have the bill, your plan's explanation of benefits (EOB), your plan card and a pen. Call the billing number on the bill. Do not pay on this call, and do not agree to a payment plan yet.

1. Say: "My name is [Your name]. I am calling about account [Account number on the bill] for services on [Date of the care]. The balance on the bill is [Balance shown on the bill]." 2. Ask: "May I have your name and a call reference number?" Write both down. 3. Say: "I have health coverage with [Name of the health plan]. I think this may be a surprise bill. The federal No Surprises Act may limit what you can bill me for emergency care, for an out-of-network clinician at an in-network hospital or surgical center, and for an air ambulance flight." 4. Ask: "Was this emergency care? Was the clinician working at a hospital or surgical center that is in my plan's network? Have you billed my plan? What did the plan pay?" Write down the answers. 5. Ask: "Did I sign a notice-and-consent form for this care? If you say yes, please send me a copy." Say you did not sign one only if that is true. Some services can never be waived, including emergency medicine, anesthesiology, pathology, radiology, neonatology, assistant surgeons, hospitalists, intensivists and diagnostic services. 6. Say: "If the Act applies, please bill me only the in-network cost sharing. Please put this account on hold while my plan reprocesses the claim, and please confirm the hold in writing." A hold is something many offices give when asked. It is not a right that the rules behind this site list, so ask politely and get the answer in writing. 7. Ask: "Please send me an itemized bill that lists each charge and its billing code." 8. Ask: "Where do I send my letter, and who will read it? What is the address, fax number or email for the billing office?" 9. If they say you must pay now, or that the account will go to collections: stay calm and say, "I am disputing this bill because the No Surprises Act may apply, and my plan is checking the claim. Please hold the account while it is checked, and note on it that it is in dispute. I am sending my request in writing today." Write down their answer, their name and the time. 10. If they say "call your insurance company": say, "I will, and I am also asking you to hold this account while that happens." 11. Write down: the name of the person, the date and exact time of the call, the reference number, what they agreed to, what they refused and what they said they would do by when. 12. Close: "Let me repeat what we agreed." Read your notes back and ask, "Is that right?" Say, "Thank you. I will follow up in writing today."

Do not rely on the call alone. Send the letter to the billing office the same day, ask your plan to reprocess the claim, and keep copies of everything. If a collection notice arrives, answer it in writing, keep a copy of what you send and ask that the account be held while the claim is checked.