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Surprise Medical Bill Story

First Name

Last Name

Email

Phone

City

State

Birthday

Race/Ethnicity

How did you get your insurance? E.g. Employer sponsored, Marketplace, Medicare, Medicaid, etc.

What is your work status? E.g. Retired, Full-Time, Part-Time, Unemployed, Student.

What were you seeking treatment for when you incurred a surprise, out of network bill?

Did your surprise, out of network bill include any emergency services? If so, please describe them.

Your Full Story

I agree to and acknowledge Familes USA's consent and release guidelines.

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Stay Up To Date

Now that the No Surprises Act protections are in effect, we continue to provide resources about the statute. See our resources tab to learn more about the new law and our efforts to keep it strong for consumers. You can also visit the Center for Medicare and Medicaid Services’ website on the law for more information:

https://www.cms.gov/nosurprises.

Contact the No Surprises Campaign

Jane Sheehan, Director of Federal Relations
JSheehan@familiesusa.org

© No Surprises: People Against Unfair Medical Bills 2024

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