If you've visited an in-network doctor or facility only to later receive a bill for out-of-network services that weren't disclosed clearly to you initially, you've been surprise billed. It's one of the deepest "screw you" feelings in the US medical system to have done the proper research to find a facility and doctor your plan will cover, only to have another pratictioner still billing you out-of-network.
Thankfully, the unfairness of this is so obvious that we've started to see positive action around surprise billing. The No Surprises Act took effect in 2022, and protects you from specific types of surprising billing resulting in balance billing (when a patient is billed above what their insurance covers) federally. Some states will also have additional protections above and beyond the federal law.
Federal Law
The No Surprises act was signed in December of 2020, and became effective January of 2022. Firstly, patients are protected from surprise bills when receiving emergency care reguardless of if they receive care from an in-network or out-of-network provider.
When receiving non-emergency care at in-network faclities, out-of-network providers are prohibited from billing patients more than the in-network cost-sharing rate. No balance billing can occur unless you are given advanced notice of the out of network provider and their rate and directly consent (a consent form will look like this).
Some states may have addional protections:
Washington
Washington state law increases consumer protections to also include emergency mental health and drug treatment services, as well as post-stabalization services after receiving emergency care.
As of January 1, 2025, Washington will also include ground ambulance emergency services in its balance billing protections.
