What Is Balance Billing and How Are You Protected?

What Is Balance Billing?

When you receive care from an out-of-network provider, they may charge more than your insurance's allowed amount. The difference — the "balance" — has historically been billed to you. This is balance billing.

Federal Protections (No Surprises Act)

Since 2022, you are protected from balance billing for:

• Emergency services (any facility)
• Non-emergency services from out-of-network providers at in-network facilities
• Air ambulance services

When Balance Billing Is Still Allowed

• Doctors' offices you chose knowing they were out-of-network
• Elective out-of-network care you consented to
• Ground ambulance services (not yet covered by federal law)
• Services at out-of-network facilities you chose

How to Dispute a Balance Bill

1. Check if the No Surprises Act applies to your situation
2. Contact your insurer — they should process the claim at in-network rates
3. Contact the provider — inform them they cannot balance bill you
4. File a federal complaint at 1-800-985-3059
5. Check state laws — many states have additional balance billing protections
6. Do not pay until the dispute is resolved

Document Everything

Keep all bills, EOBs (Explanation of Benefits), and correspondence. Note every phone call with names, dates, and reference numbers.