You did everything right. You went to an in-network hospital. Weeks later, a bill arrives from an ER doctor, radiologist or anesthesiologist you never chose, marked “out of network.” It asks you to pay the difference between their price and what your insurance paid.
For most people with private insurance, that bill shouldn’t exist. Since January 2022, a federal law called the No Surprises Act has protected patients from most surprise out-of-network bills for emergency care.
What the law protects
- Emergency care, in network or not. Your insurer must cover emergency care without prior approval. Your cost sharing (copay, coinsurance, deductible) is set at in-network levels, even if the ER or the doctor is out of network.
- No “balance billing” for emergencies. An out-of-network provider can’t bill you the gap between their full charge and what your plan paid.
- Out-of-network doctors at in-network hospitals. This includes ER doctors, radiologists, anesthesiologists and others you didn’t pick.
- Air ambulances are covered by the law.
What it doesn’t cover
- Ground ambulances. This is the biggest gap. We’ll cover it in an upcoming post.
- Some plan types, including short-term plans, fixed indemnity plans and healthcare sharing ministries.
- Medicare, Medicaid, VA and TRICARE. These programs have their own separate protections against this kind of billing.
- Care after you’re stable, in some cases, if you signed a written notice agreeing to out-of-network care. You can’t be asked to give up these protections for emergency care itself.
Red flags on your bill
- The bill says “out of network” and asks for more than your normal in-network cost sharing.
- It shows the provider’s full charge minus what insurance paid, with the rest billed to you.
- Your EOB says you owe less than the provider’s bill says.
What to do
- Don’t pay yet. Compare the bill to your insurer’s EOB. The EOB shows what you owe under the law.
- Call the provider’s billing office. Say: “This was emergency care. Under the No Surprises Act, I only owe my in-network cost sharing.” Ask for a corrected bill.
- Call your insurer if the EOB itself looks wrong or processed the claim as out of network.
- File a complaint with the federal No Surprises Help Desk at 1-800-985-3059 if the provider won’t fix it.
- Keep a record of every call: date, name and what they said.
Series wrap-up
That’s the end of our Red Flags series:
- Why ER bills are so high
- Why one visit brings several bills
- What a Level 5 charge means
- How the law protects you from surprise out-of-network bills
If you found a red flag on your bill, you don’t have to deal with it alone.
Got an out-of-network bill after an emergency? Forward it to us with your EOB. We’ll check whether it breaks the No Surprises Act and help you push back. Take action
This article is for general education and is not legal or medical advice.