What Is Balance Billing?
Balance billing occurs when an out-of-network provider bills you for the difference between what they charge and what your insurance paid.
Example: A provider charges $10,000. Your insurance pays $4,000 (the allowed amount). The provider then bills you for the $6,000 "balance." This is balance billing.
The No Surprises Act (2022)
Federal law now protects you from many surprise balance bills:
- Emergency care: You cannot be balance billed for emergency care at any hospital, regardless of network status
- Non-emergency care at in-network facilities: Out-of-network providers at in-network facilities (like anesthesiologists) cannot balance bill without advance notice and consent
- Air ambulance: Balance billing from air ambulance services is now limited
๐ก The No Surprises Act protects you in emergencies and in many situations at in-network facilities. However, it does not cover intentionally choosing an out-of-network provider.
When Balance Billing Can Still Happen
- You knowingly choose an out-of-network provider
- You receive non-emergency care at an out-of-network facility
- The provider gets you to sign a waiver acknowledging out-of-network status
How to Protect Yourself
- Always verify every provider is in-network before non-emergency procedures
- Ask specifically about anesthesiologists, radiologists, and pathologists at in-network facilities
- Never sign a waiver agreeing to out-of-network charges without fully understanding what you're signing
- If you receive a surprise bill that you believe is illegal, contact your state insurance commissioner
Calculate Your True Out-of-Pocket Cost
See what you should actually owe before paying any medical bill.
Calculate Your True Out-of-Pocket Cost โFrequently Asked Questions
Is balance billing illegal?
The No Surprises Act makes balance billing illegal in specific situations โ emergency care, and non-emergency care by out-of-network providers at in-network facilities (unless you've signed a specific waiver with advance notice). However, balance billing for intentional out-of-network care remains legal in most cases.
What do I do if I receive an illegal balance bill?
Contact your insurer first โ they may handle the dispute. If not, file a complaint with the No Surprises Act helpline (1-800-985-3059 or cms.gov/nosurprises). Your state insurance commissioner also has authority to act on improper balance bills.
Can I negotiate a balance bill?
Yes. Many providers will negotiate, especially for large amounts. You can also ask for an itemized bill to check for errors, request the provider accept your insurer's allowed amount as payment in full, or work out a payment plan if the bill is legitimate.