Why you're being billed by someone you never met

When you receive care at a hospital — even a routine procedure — multiple physicians may be involved without your knowledge. These commonly include anesthesiologists, radiologists, pathologists, and assistant surgeons. These specialists often work independently from the hospital and bill separately, sometimes through their own out-of-network practice.

This means a single hospital visit can generate bills from several different providers, not all of whom will be in your insurance network.

When federal law may limit what you owe

The No Surprises Act, which took effect in January 2022, provides protection in certain situations. If you received care at an in-network hospital or facility and an out-of-network physician provided services without your advance written consent to out-of-network billing, you may only owe your in-network cost-sharing amount.

Key situations covered Emergency care, anesthesia, radiology, pathology, and other ancillary services provided at an in-network facility are the most common scenarios where surprise billing protections apply.

The law does not cover all situations. Elective procedures where you were given advance notice and signed a consent to out-of-network billing are generally not protected.

What to check before you pay

  • Was the facility itself in-network with your insurance?
  • Did you sign any document consenting to out-of-network billing before the procedure?
  • Does your Explanation of Benefits from your insurer reference this charge?
  • Does the EOB show an in-network rate was applied, or was the claim processed out-of-network?
  • Is the physician's name and specialty clearly stated on the bill?
Do not pay immediately Paying an out-of-network physician bill before checking whether surprise billing protections apply may limit your ability to dispute the charge later.

Steps to take

1. Request an itemized bill

If you only have a summary statement, request an itemized bill from the physician's billing office. This will show the specific services, dates, and codes billed.

2. Compare the bill with your EOB

Your insurer's Explanation of Benefits will show how the claim was processed. If your EOB shows the claim was processed as out-of-network but you believe protections should apply, contact your insurer directly.

3. Contact the physician's billing office

Ask them to confirm whether they are in-network with your plan and whether a Good Faith Estimate was provided before the service. Keep a record of who you spoke to and what was said.

4. File a complaint if protections apply

If you believe the No Surprises Act applies and you are being billed incorrectly, you can file a complaint with the federal No Surprises Help Desk at 1-800-985-3059 or at cms.gov/nosurprises.

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What to say when you call

When contacting a physician's billing office about a charge you don't recognise, keep the conversation factual and specific. You might say: "I received a bill from your office for a service on [date]. I was not aware that your provider would be involved in my care and I would like to understand whether this charge is subject to the No Surprises Act before I make any payment."

Ask them to put any response in writing, and do not make a payment while the question is unresolved.