How to Cut or Even Eliminate Surprise Medical Bills

Another major error health care consumers make is assuming a shock medical bill is a verdict rather than an opening offer.

Brian O'Connell

Published: 7/7/2026, 3:11:37 PM EDT

How to Cut or Even Eliminate Surprise Medical Bills — A worker assists an elderly woman during an activity session in a Day Care center in California on Feb. 10, 2011. (Justin Sullivan/Getty Images)

On Jan. 1, 2022, the No Surprises Act officially went into effect. The legislation, enacted as part of the Consolidated Appropriations Act of 2021, targeted unexpected medical bills that were gouging U.S. consumers’ household budgets.

Almost five years later, the data shows the NSA hasn’t exactly completed its mission.

According to a report from Indiana-based Elevance Health Public Policy Institute concludes that the law's payment dispute process has generated “unexpected results” for planned medical procedures that have largely favored medical care providers and not health care consumers.

The study recorded 7,300 payment disputes involving common care procedures and services, such as spine surgery, plastic surgery, colonoscopy, and other scheduled services performed at in-network facilities by out-of-network providers. Elevance Health found that medical care providers won approximately 90 percent of disputed claims. Even worse, payments approved through the federal Independent Dispute Resolution (IDR) process often clocked in significantly higher than in-network commercial rates and Medicare payment compensation.

For instance, the typical IDR patient payout stood at $40,000, significantly higher than in-network commercial payments or Medicare prices, which ranged from $645 to $1,600. Meanwhile, provider compensation for those procedures rose 43 percent between 2024 and 2025, signaling that the NSA had little impact on surprise medical bills.

“The No Surprises Act was designed to protect patients from unexpected medical bills, not to increase healthcare costs," said Catherine Gaffigan, MD, president, health solutions at Elevance Health, in a statement. "Our Public Policy Institute’s research raises serious concerns that the dispute resolution process is being used for certain scheduled services in ways that diverge from the law's original intent.”

Here's How to Cut Surprise Medical Bills On Your Own

Even if the No Surprises Act isn’t living up to legislative standards, consumers do have proven ways of curbing shock medical bills before they can inflict real damage.

These three strategies, in particular, can save hundreds, if not thousands, of dollars that would otherwise be lost to surprise health care bills.

Start the dispute problem right away

Medical care experts say that when facing a $1,000-and-up medical bill, the smartest initial move is to shift into dispute mode right away.

“Step one is to match the bill against the EOB from the insurer,” Dr. Mike Daniels, president and chief medical officer at WeTreatFeet Podiatry, told NTD News.

That means asking yourself three key questions, Daniels said.

Was the provider coded as in‑network or out‑of‑network?
What did the plan allow?
Which portion is marked as “patient responsibility”?

“If the service was emergency, or a planned procedure at an in‑network facility, and the bill is coming from an out‑of‑network clinician involved in that episode (for example, anesthesiology, radiology, pathology), that is the textbook pattern the No Surprises Act was written to address,” Daniels noted.

Once you’ve mapped out that issue, call the insurer first, not the provider.

“Here, you ask a very direct question: 'Is this claim subject to No Surprises Act protections, and if not, why not?” Daniels noted. “Then you write down the rep’s name, ID, date, and the reason they give.”

If the insurer approves, that usually means the patient should not be seeing out‑of‑network balance billing, and the extra charges need to be reprocessed. If they say no, you, as the patient, now have their logic, and a financially literate reader can decide whether that explanation holds water.

"Only then do you call the provider or facility billing office with the same specific question,” Daniels said. “I’ve seen high‑dollar bills evaporate or shrink dramatically once the patient realizes which legal protections apply.”

Leverage Medicare data to arrive at a fair price

Medical consumers stuck with a big health care bill should also look up each Current Procedural Terminology (CPT) code on Medicare's public fee schedule and use that number as their anchor when they call the billing office.

“Ask for the self-pay price, which is frequently below the insured balance for the same service,” Zain Memon, founder and CEO at Eureka, a medical billing services company, told NTD.

If the bill is for out-of-network emergency care or an out-of-network clinician at an in-network facility, the No Surprises Act says you only owe your in-network cost sharing. “The Centers for Medicare & Medicaid Services (CMS) runs a complaint process for providers who balance-bill you anyway, and most patients never check whether their bill qualifies,” Memon noted.

Never make the initial payment move

One big mistake consumers often make with a large medical bill is paying the first amount due, especially by credit card. “That converts a negotiable medical bill into non-negotiable consumer debt,” Memon said. “A medical bill is an opening offer. Almost nothing else in American life is priced that way, which is why patients don't realize they can counter.”

Always Know Your Legal Options

Another major error health care consumers make is assuming a shock medical bill is a verdict rather than an opening offer. “They treat the number as an objective fact, not the output of a deeply imperfect process involving contract terms, coding decisions, and system defaults that can be wrong. So they start paying,” Daniels said.

Another mistake, especially among otherwise financially literate folks, is waiting too long to engage.

“They toss the envelope onto a stack of mail, intending to 'get to it',” Daniels said.

By the time the consumer really focuses, the account is flirting with collections, or worse, already there. “Now, you’re not just arguing about coverage, you’re fighting credit reporting, fees, and a third‑party collector whose business model depends on not over‑educating you about your rights,” Daniels noted.

Daniels said he understands the billpayer’s psychology, which can be fragile at this point.

“Medical bills feel murky and annoying, even for people who happily read 10‑Ks in their spare time,” he added. “But that delay costs them leverage. The cleanest wins I’ve seen happen when people act quickly, ask targeted questions, and insist on written explanations before any money changes hands.”

A former Wall Street bond trader, Brian O’Connell, is the author of two best-selling books: “The 401k Millionaire” and “CNBC’s Creating Wealth.” His work is featured on national financial and business platforms, including TheStreet.com, CBS News, CNN, The Wall Street Journal, U.S. News & World Report, Forbes, Fox News, and many others. Mr. O’Connell writes a weekly stock market column for Benzinga, and he’s served as chief insurance analyst for Insurance Quotes since 2019.

The views and opinions expressed are those of the interviewees. They are meant for general informational purposes only and should not be construed or interpreted as a recommendation or solicitation. NTD does not provide investment, tax, legal, financial planning, estate planning, or any other personal finance advice. NTD holds no liability for the accuracy or timeliness of the information provided.