No Surprises Act balance-billing protection

42 USC 300gg-111, 300gg-131/-132; 45 CFR 149.410-.440: emergency care and out-of-network clinicians at in-network facilities may bill only in-network cost sharing. Help desk 1-800-985-3059

2026-11-10

To: [provider name]
Re: account [account number]
From: [Your name]

This bill charges me more than my in-network cost sharing for care protected by the No Surprises Act (42 USC 300gg-131/-132; 45 CFR 149.410-.440). Please correct the bill to the in-network cost-sharing amount shown on my EOB and refund any excess. I am also reporting this to the No Surprises Help Desk (1-800-985-3059).

Please reply in writing.

[Your name]

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This is general information and a letter you send yourself, not legal advice. BillAdvocate does not contact anyone for you. BillAdvocate is not a law firm and is not your lawyer: letters are drafted by software (and, only if you ask, reworded by an AI service) from what you enter, and no lawyer has reviewed them. Check every fact, amount and date before you send, and talk to a lawyer or legal aid office if you are being sued or a deadline is close. These letters are not a substitute for the advice of an attorney.