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.
Surprise Billing (No Surprises Act)
Unexpected medical bills from out-of-network providers — now largely prohibited by the No Surprises Act.
Full Definition
Surprise billing occurs when you receive care at an in-network facility (like a hospital) but are unexpectedly treated by an out-of-network provider (like an anesthesiologist or radiologist) — resulting in a large bill you didn't anticipate. The No Surprises Act, which took effect January 1, 2022, prohibits most forms of surprise billing. You can only be charged your in-network cost-sharing for emergency care and for non-emergency care when you didn't have a meaningful choice of provider. Providers and insurers must resolve payment disputes through an arbitration process.
Real-World Example
You have knee surgery at your in-network hospital. The surgeon is in-network, but the assistant surgeon is not. Before the No Surprises Act, you could have received a large surprise bill. Now, the out-of-network assistant surgeon can only charge you your in-network cost-sharing amount.
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