What Is Balance Billing (Surprise Billing)?

How Balance Billing Happens

1. You receive care from an out-of-network provider (sometimes unknowingly)
2. Your insurance pays their allowed amount (e.g., $500)
3. The provider's charge is higher (e.g., $2,000)
4. The provider bills you for the "balance" ($1,500)

No Surprises Act Protections

Since January 2022, you're protected from balance billing for:

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

What You Owe

Under the No Surprises Act, you only pay:

• Your in-network cost-sharing (copay, coinsurance, deductible)
• The provider and insurer must negotiate the rest

How to Dispute a Balance Bill

1. Check if the No Surprises Act applies
2. Call your insurer and ask them to reprocess at in-network rates
3. Contact the provider's billing department and cite the law
4. File a complaint with CMS (cms.gov/nosurprises) or your state
5. Request independent dispute resolution if needed