Balance Billing

Balance billing happens when an out-of-network provider charges you the difference between what they billed and what your insurance actually paid — on top of your normal copay, deductible, or coinsurance. A $2,000 procedure where insurance pays $1,200 could leave you billed for the remaining $800, even though you were never told the provider was out-of-network.

Since 2022, the federal No Surprises Act bans this in the situations people run into most often without any real choice in the matter: emergency care regardless of which hospital you’re taken to, and out-of-network care you receive at an in-network facility (an out-of-network anesthesiologist at an in-network hospital, for example). In those cases, you’re only responsible for your normal in-network cost-sharing — the provider and insurer have to work out the rest between themselves.

The protection has real limits, though. If you knowingly and willingly choose an out-of-network provider for planned, non-emergency care — and sign a specific written consent form acknowledging the out-of-network status and estimated cost — balance billing can still apply. Always check network status before a planned procedure, and if a bill shows up that looks like illegal balance billing, dispute it directly with the provider citing the No Surprises Act before it turns into a collections problem.

Frequently asked

Is balance billing always illegal now?

No — the No Surprises Act only bans it in specific situations, mainly emergency care and certain out-of-network care received at an in-network facility. Planned, out-of-network care you knowingly choose can still be balance billed.

Show more

— US Debt Compass Editorial Team

What do I do if I get an illegal balance bill?

Dispute it with the provider in writing citing the No Surprises Act, and if that doesn't resolve it, file a complaint through the federal No Surprises Help Desk.

Show more

— US Debt Compass Editorial Team