What Is Balance Billing?

Balance billing happens when an out-of-network provider bills you for the gap between what they charged and what your insurance paid — leaving you with an unexpected bill, sometimes for thousands of dollars.

How It Happens

You go to an in-network hospital. Your insurance pays the hospital's in-network rate. But one of the doctors who treated you — say, the anesthesiologist or radiologist — is employed by a separate group that isn't in your network. They bill their full rate. Your insurance pays their out-of-network rate (if your plan covers out-of-network at all). They bill you for the difference.

The No Surprises Act (Effective 2022)

Federal law now protects you from most surprise balance bills. Key protections:

• Emergency care: You cannot be balance billed for emergency services, regardless of network status
• Non-emergency care at in-network facilities: Providers must give you advance notice if they're out-of-network and get your consent before balance billing
• Air ambulance: New protections limit balance billing from air ambulance services

What's Not Protected

• Ground ambulance (still working through state laws)
• Situations where you knowingly chose an out-of-network provider
• Some facility fees and ancillary charges

If You Receive a Balance Bill

1. Don't automatically pay it
2. Verify whether the No Surprises Act applies to your situation
3. Contact your insurance company — they have dispute resolution processes
4. You can also file a complaint at CMS.gov or call 1-800-985-3059