What a Surprise Bill Is and Your Rights

A surprise bill occurs when you receive care from an out-of-network provider at an in-network facility. This often happens during emergencies when you have no choice in who treats you. Because these providers do not have a contract with your insurance plan, they may charge you the full difference between their fee and what your insurance pays. This creates an unexpected and often large financial burden.

The No Surprises Act is a federal law that went into effect in 2022 to stop these charges. It prevents providers from billing you more than your standard in-network cost-sharing amount for emergency services. This law also applies to non-emergency services provided by out-of-network staff at in-network hospitals. You are only responsible for your regular deductible, copayment, or coinsurance.

For non-emergency services, a provider must give you a written notice if they are out-of-network. This document explains your rights and asks for your consent to be billed at a higher rate. You have the right to refuse this consent and request an in-network provider instead. If you do not sign this waiver, you cannot be charged more than the in-network rate.

If you receive a bill that you believe violates these protections, do not pay it immediately. Contact the healthcare provider or facility first to explain that the charge appears to be a surprise bill under the new law. If they do not correct the error, file a complaint with the federal government's help desk or your state’s insurance department. You have the right to dispute charges that you believe are unfair or inaccurate.