Balance Billing
When an out-of-network provider bills you for the difference between their charge and what insurance pays.
What is Balance Billing?
Balance billing (also called surprise billing) occurs when an out-of-network provider bills you for the difference between their full charge and what your insurance pays. This can result in large unexpected bills.
For example, if a provider charges $1,000 and your insurance pays $400 (the usual and customary rate), the provider might balance bill you for the remaining $600 - on top of any deductible or coinsurance you owe.
The No Surprises Act (2022) protects against surprise balance billing in many emergency situations and when you unknowingly receive care from out-of-network providers at in-network facilities. But balance billing can still occur in some situations, particularly when you knowingly choose out-of-network care.
Frequently Asked Questions
Is balance billing legal?
Sometimes. The No Surprises Act banned it in emergencies and surprise situations. Knowing out-of-network care can still result in balance bills.
How can I avoid balance bills?
Stay in-network when possible. Before procedures, ask if all providers involved are in-network. Verify network status for anesthesiologists and other specialists.
Can I negotiate a balance bill?
Yes. Many providers will negotiate or accept a lower amount. Ask for an itemized bill and compare to typical rates for the service.
Related Terms
Learn More
Track your HSA expenses
Now that you understand the terms, put your knowledge to work. Track expenses and reimburse yourself tax-free.
Get Started Free