Balance Billing (Surprise Billing)

Balance billing happens when a provider outside your insurance network charges you for the "balance" between its full price and the amount your insurer paid. In-network providers have agreed to accept the insurer's rate, so they generally cannot do this. The problem hit hardest in emergencies and at in-network hospitals where an out-of-network anesthesiologist, radiologist, or ambulance treated the patient without any choice on their part. Those unexpected charges are called surprise bills.

The federal No Surprises Act, which took effect January 1, 2022, protects people with most types of health insurance from unexpected out-of-network bills for emergency room visits and for certain non-emergency care at in-network facilities. In those situations you should owe only your normal in-network cost sharing, such as your copay, coinsurance, or deductible. The law also gives uninsured and self-pay patients the right to a good faith estimate and a way to dispute bills that come in well above it.

If you get a bill that looks like a banned surprise bill, do not ignore it and do not pay it right away. Compare it with your insurer's explanation of benefits, ask the provider for an itemized bill, and file a complaint with the federal No Surprises Help Desk or your state insurance department. Some states have their own balance billing laws that add protection.

Class actions sometimes target providers or billing companies that allegedly sent bills the law did not allow, or that sent unpaid bills to collections. Collection efforts on improper medical bills can also raise debt collection and credit reporting issues. See our pages on debt collection lawsuits and credit report errors.