Surprise Billing

A surprise bill is a medical bill a patient receives from an out-of-network provider for care they received at an in-network facility — without being told in advance that the provider was out-of-network. The classic scenario: you go to an in-network hospital for an in-network surgeon, and two months later you get a separate bill from the anesthesiologist, the radiologist, or the ER physician group — all of whom were contracted separately and happen to be out-of-network. The patient had no meaningful ability to choose these providers.

The No Surprises Act, effective January 1, 2022, addressed this for most situations. For emergency care, plans must pay out-of-network providers at the in-network cost-sharing rate regardless of their contract status, and patients can only be charged in-network cost-sharing amounts. For non-emergency care at in-network facilities, providers must give patients a notice and consent form at least 72 hours in advance if they're out-of-network and want to charge more than the in-network rate — and patients must affirmatively consent in writing before being billed at higher out-of-network rates. When the plan and provider can't agree on payment, they go through an Independent Dispute Resolution (IDR) process, not the patient. The law has significantly reduced surprise billing for commercially insured patients, but enforcement gaps remain: some providers still send non-compliant surprise bills, and many patients don't know they have the right to dispute them. Ground ambulance services are specifically excluded from the No Surprises Act's protections and remain a common source of surprise bills.

The takeaway: if you receive a surprise bill from an out-of-network provider for care at an in-network facility, you likely have rights under the No Surprises Act. Contact your plan immediately and request an explanation of benefits that shows the correct in-network cost-sharing. You should not pay out-of-network rates for providers you didn't choose and couldn't have reasonably avoided.