Since this bill can come as a shock, it’s also known as “surprise billing.” Unfortunately, it’s a fairly common scenario. Researchers found that over 20% of patients having surgery at an in-network hospital with in-network physicians ended up with thousands of dollars worth of unexpected out-of-network charges. However, out-of-network providers aren’t bound by the same restrictions and are free to bill you for the remaining fees. It’s important to consider all potential costs when determining whether to choose an in-network or out-of-network provider. You can also experience these bills in an emergency situation. About 18% of emergency room visits result in unexpected medical bills because patients are seen by out-of-network providers. In an emergency, you can’t always pick which hospital you go to or which doctor treats you. This makes it more likely that you’ll be treated by an out-of-network provider.
When Is Balance Billing Not Allowed?
To help protect their clients from unexpected medical bills, some insurance companies have banned balance billing. For example, Medicare providers are prohibited from balance billing qualified Medicare patients. Some states also banned this practice in certain situations. For instance, Nebraska and California are two of a growing number of states that have passed laws banning balance billing for emergency care. The No Surprises Act took effect in 2022 as a way of protecting patients from receiving surprise medical bills for emergency services and at in-network facilities. The law also includes other measures aimed at making the process more transparent for patients.
