Balance Billing and Surprise Medical Bills: Know Your Rights
The No Surprises Act protects you from surprise medical bills. Learn about balance billing, out-of-network protections, and how to dispute charges.
Potential savings: $500-$50,000
Balance billing occurs when an out-of-network provider bills you for the difference between their charge and what your insurance paid. Before the No Surprises Act took effect in January 2022, patients routinely received surprise bills of thousands of dollars from out-of-network providers they did not choose, particularly in emergency situations. Understanding your rights under federal and state law is critical to protecting yourself from these charges.
What Is Balance Billing and Surprise Medical Bills?
Balance billing (also called surprise billing) happens when you receive care from an out-of-network provider and they bill you for the balance between their full charge and what your insurance company pays. For example, if a surgeon charges $10,000, your insurance pays $6,000 (the in-network rate), and the surgeon bills you for the remaining $4,000. The No Surprises Act now prohibits this in most emergency and many non-emergency situations where you did not have a choice of provider.
Common Billing Errors
Receiving a balance bill from an out-of-network emergency provider. Under the No Surprises Act, emergency services are protected regardless of network status. You should only owe your in-network cost-sharing amount (copay, coinsurance, deductible).
Out-of-network ER physician feesReceiving balance bills from anesthesiologists, radiologists, pathologists, or assistant surgeons who were out-of-network at an in-network facility. These providers are specifically covered under the No Surprises Act when you did not have the ability to choose them.
Out-of-network anesthesiologist at in-network hospitalAfter emergency stabilization, being transferred to an out-of-network provider or facility and receiving balance bills for post-stabilization care. The No Surprises Act extends protections to post-stabilization services until you can safely be transferred or you consent to out-of-network care.
Out-of-network air ambulance services are specifically covered under the No Surprises Act. If you are transported by an out-of-network air ambulance, you should only owe in-network cost-sharing. Ground ambulance services are not yet covered by the law.
How to Spot These Errors on Your Bill
- 1
Check if the billed amount exceeds your in-network cost-sharing (copay + coinsurance + deductible) for any emergency service.
- 2
Look for separate bills from providers you did not choose at an in-network facility.
- 3
Review the date of service to determine if protections apply (No Surprises Act covers services from January 2022 onward).
- 4
Check whether you signed a consent form agreeing to out-of-network rates, which could waive your protections for non-emergency services.
- 5
Compare the amount billed against what your insurance EOB says you owe to identify potential balance billing.
Frequently Asked Questions
What is the No Surprises Act?
The No Surprises Act is a federal law effective January 1, 2022, that protects patients from surprise out-of-network medical bills. It applies to emergency services (regardless of where provided), non-emergency services at in-network facilities from out-of-network providers you did not choose, and air ambulance services. Under this law, you only pay your in-network cost-sharing amount.
What should I do if I receive a surprise bill?
Do not pay the bill immediately. First, check if the No Surprises Act or your state surprise billing law applies. Contact your insurance company to file a complaint. You can also submit a complaint to CMS at 1-800-985-3059 or through the No Surprises Help Desk. If protections apply, the provider must withdraw the bill and can only charge your in-network cost-sharing amount.
Does the No Surprises Act cover ground ambulances?
No, ground ambulance services are currently excluded from the No Surprises Act. However, an advisory committee is studying the issue and may recommend future legislation. Some states have their own protections for ground ambulance balance billing. Check your state laws for applicable protections.
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Learn what balance billing is, when it's illegal, and step-by-step instructions for disputing surprise medical bills under the No Surprises Act.
A comprehensive guide to the federal law that protects you from surprise medical bills at in-network facilities and during emergencies.
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