Balance billing
When an out-of-network provider bills you the difference between their charge and what your plan paid. Mostly banned by the No Surprises Act for emergency and certain non-emergency situations.
Balance billing happens when an out-of-network provider bills the patient for the difference between what they charged and what the insurance plan paid. The No Surprises Act (effective 2022) banned balance billing for: (1) emergency services from out-of-network providers and facilities, (2) post-stabilization care, (3) air ambulance, (4) out-of-network providers at in-network facilities (anesthesiology, radiology, pathology, etc.). Ground ambulance is NOT covered by NSA (some states have layered protections). Patients receive a Good Faith Estimate for scheduled self-pay services.
Frequently asked questions
What is balance billing?
Balance billing happens when an out-of-network provider bills the patient for the difference between what they charged and what the insurance plan paid. The No Surprises Act (effective 2022) banned balance billing for: (1) emergency services from out-of-network providers and facilities, (2) post-stabilization care, (3) air ambulance, (4) out-of-network providers at in-network facilities (anesthesiology, radiology, pathology, etc.). Ground ambulance is NOT covered by NSA (some states have layered protections). Patients receive a Good Faith Estimate for scheduled self-pay services.
Is this relevant to a denial appeal?
If you've been balance-billed for NSA-protected services, file a complaint with HHS at 1-800-985-3059.
Related terms
- No Surprises Act (NSA)Federal law (effective 2022) banning balance billing for most emergency and certain non-emergency ou
- Out-of-network (OON)A provider who doesn't have a contract with your plan. Cost-sharing is higher and you may face balan
- Federal IDR (No Surprises Act dispute resolution)The 'baseball arbitration' process between out-of-network providers and plans for NSA-covered servic
Appeal a denial
If you've been balance-billed for NSA-protected services, file a complaint with HHS at 1-800-985-3059.
Get started →Contact: hello@denialhelp.com