MEDICAL BILLS

What is balance billing and is it legal?

SHORT ANSWER

Balance billing is when a provider bills you for the difference between their full charge and what your insurer paid or allowed. For emergency care and most out-of-network care delivered at in-network facilities, the federal No Surprises Act makes this kind of "surprise" balance bill illegal.

Balance billing happens when a doctor, hospital, or lab charges you the gap between their sticker price and the amount your insurance considered allowable. In ordinary in-network care it’s generally not allowed by the provider’s contract. The area people get burned by is out-of-network surprise bills — an ER visit, or an out-of-network anesthesiologist at an in-network hospital. Since January 1, 2022, the No Surprises Act bans most of those surprise balance bills and limits your cost to your normal in-network share.

What to do, in order

  1. Get an itemized bill and your insurer’s Explanation of Benefits (EOB) and lay them side by side.
  2. Check whether the care was emergency, or out-of-network care at an in-network facility — those are protected.
  3. Confirm you were only charged your in-network cost share for protected services.
  4. If you were surprise-billed for protected care, dispute it citing the No Surprises Act.
  5. For uninsured/self-pay care, ask for a Good Faith Estimate and challenge bills that far exceed it.

Common questions

Does the No Surprises Act cover all balance billing?

No. It targets surprise bills: emergency services and certain out-of-network care at in-network facilities. Care you knowingly chose out-of-network, with proper notice and consent, can still be balance billed.

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

Don’t pay it reflexively. Compare the bill to your EOB, tell the provider and your insurer it violates the No Surprises Act, and use the federal dispute process if it isn’t corrected.

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This is general information, not legal, tax, or financial advice, and it doesn’t create a professional relationship. Rules have exceptions and change over time. For advice on your specific situation, consult a licensed professional.