What Is Balance Billing?
Balance billing (also called surprise billing) happens when an out-of-network provider charges you the difference between their full rate and what your insurance paid. For example, if a surgeon charges $15,000 and your insurance pays $8,000, the provider could balance-bill you for the remaining $7,000.
The No Surprises Act (2022)
The federal No Surprises Act protects you from balance billing in these situations:
- Emergency care: You can only be charged in-network rates, regardless of which ER you go to
- Non-emergency care at in-network facilities: If an out-of-network provider treats you at an in-network hospital (common with anesthesiologists, radiologists, pathologists), you're protected
- Air ambulance services: From out-of-network providers
When You're NOT Protected
- You voluntarily choose an out-of-network provider and sign a consent waiver
- Ground ambulance services (not covered by the No Surprises Act)
- Non-ACA plans (short-term, indemnity) — the No Surprises Act protections may not apply
If you receive a surprise bill: Don't pay it immediately. Check your EOB, verify the provider was actually out-of-network, and contact your insurer. If the No Surprises Act applies, the provider must reprocess the bill at in-network rates. You can also file a complaint at cms.gov/nosurprises.
Related Terms
Last updated: March 30, 2026.
