Balance Billing - What It Is and Your No Surprises Act Rights
Balance billing is illegal in emergencies and at in-network facilities. Know your rights under the No Surprises Act.
Written by FairVisitHealth Editorial Team · Healthcare Pricing Analysts
Medically & editorially reviewed by the FairVisitHealth Clinical Team (Clinical & Billing Review). Data sourced from CMS, HRSA, and hospital price transparency filings.
Balance Billing Explained
Balance billing occurs when an out-of-network provider bills you the difference between their charge and insurance payment. A surgeon charges $10,000, insurance pays $4,000, and you get billed $6,000.
No Surprises Act Protections
Since January 2022: no balance billing for emergency services at any facility, and no balance billing from providers you didnt choose at in-network facilities (anesthesiologists, radiologists, pathologists).
How to Dispute
Call billing and reference the No Surprises Act. File a complaint at cms.gov/nosurprises. Contact your state insurance commissioner. Penalties reach $10,000 per violation.
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