Surprise bill support as a benefit
A surprise bill is a bill from an out of network provider the person didn't choose, often after emergency care or a procedure at an in-network hospital. A balance bill is the provider charging the gap between its price and what the plan paid.
As a benefit, mediloop checks whether the No Surprises Act or a good faith estimate dispute applies to the bill, and a human advocate takes it up with the provider or plan. When no federal protection applies, the advocate works the other routes: billing errors, financial assistance and negotiation.
Strong protections, with gaps people fall into.
The No Surprises Act
Federal protections against surprise out of network bills in many situations, such as emergency care, with a separate dispute process for payment disagreements between providers and plans.
Good faith estimates
Uninsured and self-pay patients are entitled to a good faith estimate, and can dispute a final bill that comes in $400 or more above it, within 120 days, for a $25 fee.
The ground ambulance gap
Ground ambulance services are generally not covered by the No Surprises Act protections unless state law says otherwise, so they may still bill at out of network rates.
While a good faith estimate dispute is pending, the provider can't send the bill to collections or threaten to.
Find the protection first. Then use it.
The person sends the bill
An employee or member uploads the bill, the EOB and any estimate they were given, and authorizes their own case.
AI-powered investigation
mediloop's AI reads the documents and flags what points to a protected bill: network status, care setting, the estimate against the final amount.
A human advocate acts on it
The advocate raises the protection with the provider or plan, files a dispute when one applies, and works the other routes when it doesn't.
Where these facts come from
- CMS, No Surprises Act, Centers for Medicare & Medicaid Services
- CMS, Know your rights when using insurance, Centers for Medicare & Medicaid Services
- CMS, Understanding costs in advance (good faith estimates), Centers for Medicare & Medicaid Services
- CMS, Dispute a medical bill (patient-provider dispute resolution), Centers for Medicare & Medicaid Services
- eCFR, 45 CFR 149.620, patient-provider dispute resolution, US Government Publishing Office, Electronic Code of Federal Regulations
Surprise bills, answered.
Billing errors · Hospital financial assistance · Insurance denials · Security and data · For employers
Last reviewed
Make sure people know when a bill isn't theirs to pay.
Tell us about your organization and the surprise bills people bring to you. We'll review the fit and come back to you about a pilot.
Prefer email? sales@mediloop.ai