Medical bills are complicated, and sometimes they include charges that the law doesn’t allow. Some bans are federal and protect most patients, while others are state-specific or apply to Medicaid or Medicare. Even so, these fees still pop up on statements and portals, especially after emergency visits or when records are requested.
If any of these show up, ask the provider to remove the charge and cite the rule below. When needed, file a complaint with your state regulator or a federal agency.
Out-of-network emergency balance bills
Under the federal No Surprises Act, providers can’t send you a “balance bill” for emergency care at out-of-network facilities. Your plan must treat these as in-network for cost sharing, and the doctor and insurer have to resolve any payment dispute without involving you.
If you get a post-ER out-of-network charge above your in-network copay/coinsurance/deductible, ask for removal and reference the law. Ground ambulances aren’t covered by the federal ban, but most other ER care is.
Surprise bills from out-of-network specialists at in-network hospitals
You went to an in-network hospital, then got a big bill from an out-of-network anesthesiologist, radiologist, or pathologist. In many cases, that’s illegal now. The No Surprises Act bans balance billing for most non-emergency services from out-of-network providers working at in-network facilities.
Your cost share should be the in-network amount. If you see an “OON provider fee” from your in-network hospital visit, ask for it to be zeroed out.
Air ambulance balance bills
Air ambulance trips are notoriously expensive, and surprise bills were common. The No Surprises Act bans out-of-network balance billing for air ambulance services. You may still owe your normal in-network cost sharing, but not the huge “balance” between the list price and what your plan pays.
If a helicopter or fixed-wing provider sends you a big out-of-network bill, cite the federal rule.
Cost-sharing above in-network amounts in protected situations
Even when a service is out-of-network, if it falls under No Surprises Act protections (emergency care, covered non-emergency services at in-network facilities, or air ambulance), your cost sharing must be limited to what you’d pay in-network.
If a statement shows an out-of-network deductible or higher coinsurance for a protected claim, ask the plan and provider to reprocess at the in-network level as required by law.
ER “pay-to-be-seen” or triage fees before screening
Hospitals can’t delay an emergency medical screening exam to check insurance or collect payment. Charging a “door fee” or requiring payment before screening violates EMTALA, the federal emergency care law.
Reasonable registration is allowed only if it doesn’t slow care. If you’re billed an upfront ER screening fee tied to being seen, challenge it and cite EMTALA guidance.
Fees for interpreter or language-access services
Providers that receive federal funds (most hospitals and clinics) must offer language assistance at no charge under Title VI and Section 1557. That includes qualified interpreters in person, by phone, or by video.
If your bill includes an “interpreter” or “translation” line, ask the provider to remove it and point to federal civil rights requirements for free language access.
Balance billing Medicaid patients for covered services
Federal Medicaid rules require enrolled providers to accept the program’s payment (plus any small, allowed copay) as payment in full. Billing a Medicaid patient for the “balance” is prohibited.
If you have Medicaid and get a bill for a covered service, cite the rule and ask the office to write it off.
“No-show” or missed-appointment fees for Medicaid members
Many state Medicaid programs explicitly forbid providers from charging members no-show fees or other administrative penalties. If you’re a Medicaid patient and see a missed-appointment charge, point to your state’s policy, several states bar these fees outright, and ask for removal.
Excessive per-page charges for electronic medical records
HIPAA gives you the right to copies of your records for a “reasonable, cost-based fee.” For electronic records, per-page fees are not considered reasonable.
If you’re billed per page for a PDF or portal download, or charged more than basic labor, supplies, and postage, ask for a corrected, HIPAA-compliant invoice.
Medicare “excess charges” above the legal limit
Some doctors don’t accept Medicare “assignment.” Even then, federal rules cap what they can bill you; the “limiting charge” is generally 15% above the Medicare-approved amount.
If a Part B claim shows charges beyond that cap, ask the provider to correct it and reference Medicare’s limiting-charge rules.
Copays for ACA-required preventive services
Most private health plans must cover recommended preventive services, like many vaccines, screenings, and counseling, without copays or coinsurance, even before you meet the deductible.
If a bill lists cost sharing for a covered preventive item or service, ask your plan to reprocess it as no-cost preventive care.
Facility fees for telehealth (in states that ban them)
Several states limit or ban separate “facility fees” for telehealth visits. Connecticut, for example, prohibits hospitals and telehealth providers from charging facility fees for telehealth services.
If a telehealth visit includes a hospital facility line, check your state’s rules and request removal where banned.
Facility fees on preventive services (where restricted)
Some states restrict facility fees on basic outpatient preventive care. In Colorado, as of July 1, 2024, providers and health systems may not charge patients a facility fee for preventive services delivered in outpatient settings.
If your statement shows a separate facility fee on a routine screening or vaccine, ask for a correction under state law.
Charity-care eligible patients charged more than “amounts generally billed”
Nonprofit hospitals must limit charges for emergency and medically necessary care for patients eligible under their financial assistance policy. The IRS 501(r) rules cap what FAP-eligible patients can be billed (no more than “amounts generally billed” to insured patients) and restrict aggressive collections.
If you qualify for hospital financial assistance but see list-price charges, ask for a recalculation.
Bills to patients for “never events” or certain hospital-acquired conditions
Medicare and Medicaid restrict payment for serious, preventable hospital-acquired conditions. In Medicare Advantage guidance, CMS has stated that when a plan doesn’t pay a hospital for a “never event” or HAC, the Medicare-certified hospital may not bill the member for those charges.
If you see a patient bill tied to a listed HAC, challenge it and reference these payment and billing protections.
