Aetna: surprise medical bill
Check the bill against the EOB, tell Aetna and the provider, then contact the CMS help desk.
What does this mean?
Grade A (high: almost everything comes from official pages read directly). 97% of 38 sources are the organization's own pages or government sites.
Collect
- the bill
- EOB
- member ID card
Steps
Compare the bill with the EOB. Note whether it was emergency care or care at an in-network facility.
Tell Aetna and the provider the bill may be a surprise bill.
Contact the CMS No Surprises Help Desk.
Rules in force
- No Surprises Act (surprise billing protections and good faith estimates)45 CFR part 149 (including 149.420 and 149.610)
Protects patients from out-of-network surprise bills for emergency care, for non-emergency care by out-of-network providers at in-network hospitals and surgery centers, and for air ambulance services. People who are uninsured or not using insurance get a good faith estimate and can dispute a bill that is at least $400 over the estimate.
Source: cms.gov, verified 2026-10-12
8 citable points
- Limit
For emergency services, "you can't be charged any more for emergency medical services than the in-network 'cost-sharing' rate". This covers the hospital, the providers who treat you there, and air ambulance providers.
Source: cms.gov, verified 2026-10-12
- Policy
The protections cover non-emergency care related to a visit to an in-network hospital, hospital outpatient department or ambulatory surgical center, and air ambulance services. Ground ambulance services generally are not covered by the No Surprises Act billing protections.
Source: cms.gov, verified 2026-10-12
- Policy
A patient gives up the protections for non-emergency care only by signing a notice-and-consent form. Providers of ancillary services cannot use that form: emergency medicine, anesthesiology, pathology, radiology and neonatology; assistant surgeons, hospitalists and intensivists; diagnostic services including radiology and laboratory; and any out-of-network provider when no in-network provider is available at the facility.
Source: law.cornell.edu, verified 2026-10-12
- Deadline
A notice-and-consent form for services scheduled at least 72 hours in advance must be given not later than 72 hours before the services. For services scheduled within 72 hours, it must be given on the day of scheduling, and no later than 3 hours before the services if given on the same day.
Source: law.cornell.edu, verified 2026-10-12
- Deadline
Uninsured or self-pay patients must get a written good faith estimate: not later than 1 business day after scheduling when care is scheduled at least 3 business days ahead; not later than 3 business days after scheduling when scheduled at least 10 business days ahead; and not later than 3 business days after a request.
Source: law.cornell.edu, verified 2026-10-12
- Deadline
Patient-provider dispute resolution is available when the provider charged "$400 or more" than its good faith estimate, for care on or after January 1, 2022, with an initial bill dated within the last 120 calendar days. The patient pays a "$25 non-refundable administrative fee".
Source: cms.gov, verified 2026-10-12
- Policy
While a patient-provider dispute is in progress, the provider or facility may not move the bill to collections or threaten to, and must stop pursuing payment of a bill already in collections until the dispute is resolved.
Source: cms.gov, verified 2026-10-12
- Contact
No Surprises Help Desk: 1-800-985-3059, weekdays 8:00 am to 8:00 pm ET and weekends 10:00 am to 6:00 pm ET. Complaints can also be filed online through CMS.
Source: cms.gov, verified 2026-10-12
- Limit
If that fails, escalate
Go up one step at a time. Keep the reference numbers and dates from each contact.
Customer service
Use the number on the back of the member ID card.
Written complaint
Internal appeal or grievance. Medicare plans use the Medicare appeal addresses.
State agency
Your state’s insurance department. Find it in the list of state agencies (also as JSON:
states/<code>.json, for example states/ny.json).External review for fully insured plans; complaint to the state where the plan is issued.
Federal regulator
Employer self-funded (ERISA) plans. Aetna's own External Review Program covers self-funded plans whose sponsor elects it.
Federal regulator
Surprise bills under the No Surprises Act.
Watch out
- Member phone numbers are plan-specific; Aetna directs members to the number on the ID card.
- Non-Medicare appeal addresses differ by plan; use the address on the EOB or denial letter.
- Claims and EOBs need member login.
Let your AI agent handle this
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1. Set it up (needs uv):
uvx escalate-anything setup2. Ask your agent:
I got a surprise bill for [amount] with Aetna coverage. Use Escalate Anything to dispute it.Source code, other install options and the Claude Code plugin