Surprise billing
Surprise billing is when a patient gets an unexpected bill for out-of-network care they didn't choose or didn't know was out of network. Balance billing is the practice of billing the patient for the difference between the provider's charge and what the plan paid.
When does surprise billing happen?
Typically in emergencies, when an out-of-network clinician treats a patient at an in-network hospital, or when a patient relied on wrong network information.
What does the No Surprises Act do about it?
Since 2022, it protects patients from surprise bills for most emergency care, for certain non-emergency care from out-of-network providers at in-network facilities, and for air ambulance services. It also includes the provider directory rules that limit cost-sharing when a member relied on a wrong listing.
Where does provider data come in?
Accurate network status in the directory is the plan's first line of defence against a surprise bill.