When you receive medical services at an in-network hospital or ambulatory surgery center, you are protected from surprise billing — sometimes referred to as balance billing or out-of-network billing.

What is Surprise Billing?

Health insurance plans will contract with area providers and health institutions to provide medical services where they will cover some or all of an individual’s medical bills.  When this occurs it is considered in-network billing.  Often, you are limited to receiving care from a contracted or preferred clinic, hospital or ambulatory surgical center.

When you need out-of-network care unexpectedly, your insurance may ask you to pay the difference between their in-network cost and the provider’s charges that are out-of-network.  This is often called balance billing.  In many cases, balance billing does not count towards your out-of-network limits and you are left with an unexpected or surprise amount to pay.

The New Law

As of January 1, 2022, a law has been enacted to protect patients from being billed for costs above your in-network rates when you seek care at an in-network provider.  What this means is you will only be responsible for your plans in-network coinsurance amounts and/or deductible amounts even if you happened to be seen by an out-of-network provider at the in-network facility you arrived at.  The exception would be if you agreed in advance and signed a written consent where you agreed to be billed for out-of-network services.  You cannot be billed for services above your in-network rate without your written consent.  A provider cannot ask you to give up this protection.