Kaiser Permanente: surprise medical bill
For out-of-network emergency care, submit the claim to Kaiser Permanente, compare the bill with the EOB, then contact the CMS help desk.
What does this mean?
Grade A (high: almost everything comes from official pages read directly). 94% of 34 sources are the organization's own pages or government sites.
Collect
- the bill
- EOB
- member ID card
- emergency visit records
Steps
Submit the out-of-plan emergency claim to Kaiser Permanente for reimbursement (see claims help).
Compare the provider bill with the EOB. Tell Kaiser Permanente and the provider that the bill may be a surprise bill.
Contact the CMS No Surprises Help Desk.
More contacts for this issue
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 member services number on the back of the member ID card for your region, or send a secure message.
Written complaint
Grievance or appeal. Track it in the grievance case status page.
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. In California, HMO plans are regulated by the Department of Managed Health Care.
Federal regulator
Employer self-funded (ERISA) plans.
Federal regulator
Surprise bills under the No Surprises Act.
Watch out
- Member services messages, claims summaries and grievance status need a kp.org login.
- Member services numbers differ by region and plan (Medicare, Medi-Cal, choice products); the number on the member ID card takes precedence. Numbers for Colorado, Georgia, Hawaii and Mid-Atlantic were not confirmed for HMO members.
- The complaint page and EOB give the region-specific appeal procedure.
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 Kaiser Permanente coverage. Use Escalate Anything to dispute it.Source code, other install options and the Claude Code plugin