Tip for NSA Complaint

The No Surprises Act protects you from surprise bills for emergency services, out-of-network providers at in-network facilities, and air ambulance services

Tip for NSA Complaint

You should NOT have been asked to waive your surprise billing protections for emergency services

Tip for NSA Complaint

If you signed a consent to waive protections for non-emergency services, you may still have rights under state law

Insurancemoderate

Surprise Billing Complaint

NSA Complaint · CMS / State Regulatory Agencies

Complaint form for violations of the No Surprises Act, including balance billing by out-of-network providers in emergency or in-network facility settings, or failure to provide good faith estimates.

Form Details

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Where to Submit This Form

🌐

File through CMS No Surprises Help Desk

https://www.cms.gov/nosurprises

File a complaint about surprise billing violations.

📬

Mail complaint to CMS

Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, MD 21244

Required Attachments

📎 Copy of the surprise bill
📎 Copy of your insurance card (front and back)
📎 Explanation of Benefits (EOB) from your insurer
📎 Written description of the surprise billing situation
📎 Any correspondence with the provider or insurer about the bill

Processing Time

CMS will investigate and respond within 60 days. Enforcement actions may take longer.

What Happens Next

CMS will investigate the complaint. If the provider or insurer violated the No Surprises Act, CMS can impose penalties and require corrective action. You should not pay the disputed amount while the complaint is pending.

Tips for This Form

✓ The No Surprises Act protects you from surprise bills for emergency services, out-of-network providers at in-network facilities, and air ambulance services
✓ You should NOT have been asked to waive your surprise billing protections for emergency services
✓ If you signed a consent to waive protections for non-emergency services, you may still have rights under state law
✓ Contact your state Attorney General and state Department of Insurance to file parallel complaints

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