This content is for general informational purposes and does not constitute medical, legal, or financial advice. Healthcare rules and costs change annually. Last reviewed: January 1, 2025. Always verify current details with your insurer, employer, or a licensed healthcare navigator.
Balance Billing
When an out-of-network provider bills you for the difference between their charge and your insurer's payment.
Full Definition
Balance billing occurs when an out-of-network provider bills you for the difference between what they charged and what your insurer paid. For example, if a provider charges $5,000, your insurer pays $2,000 (based on their allowed amount), and you're billed the remaining $3,000 — that's balance billing. In-network providers cannot balance bill you. The No Surprises Act (effective 2022) prohibits balance billing in many common situations, including emergency care and care at in-network facilities from out-of-network providers.
Real-World Example
You go to an in-network hospital, but an anesthesiologist who's out-of-network performs your surgery. Under the No Surprises Act, that anesthesiologist cannot balance bill you — they must work out any payment dispute with your insurer directly.
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