Surprise billing
Unexpected balance bills from out-of-network providers involved in a patient's emergency care or services delivered at an in-network facility.
Updated
Surprise billing is a form of balance billing that arises when a patient receives care from an out-of-network provider in situations the patient did not choose, such as emergency services or services ancillary to a planned procedure at an in-network facility.
Common examples include out-of-network anesthesiologists, radiologists, or laboratory services involved in care at an in-network hospital, where the patient had no opportunity to select an in-network provider.
In practice
Surprise bills typically appear as patient-responsibility balances after claims process at out-of-network rates. Under the No Surprises Act, providers generally may not balance bill patients in these scenarios and must instead pursue payment through the federal independent dispute resolution process.
Commonly confused with
- Balance billing: Balance billing is the broader practice of billing patients for out-of-network differences; surprise billing is the subset involving unexpected, non-elective out-of-network care.