What Is Balance Billing?

Balance billing happens when a healthcare provider charges a patient for the difference between their full rate and what the insurance company has agreed to pay. This can lead to unexpected medical bills, especially when a patient unknowingly receives care from an out-of-network provider.

Why is balance billing a concern?

• Surprise medical costs: Patients may assume their insurance covers everything, only to receive a large bill later.
• Out-of-network risks: Even if a hospital is in-network, certain providers (e.g., anesthesiologists and radiologists) may not be, leading to unexpected charges.

Legal protections against balance billing

• The No Surprises Act protects patients from balance billing for emergency services and certain scheduled in-network procedures.
• Some state laws further limit when and how providers can issue balance bills.

How to avoid balance billing

• Confirm provider networks before treatment.
• Request a cost estimate and ask about potential out-of-network charges.
• Know your rights—some balance bills can be disputed or negotiated.

How Solace can help

A Solace advocate can review medical bills for errors, dispute unfair charges, and guide patients through insurance appeals to reduce or eliminate balance billing costs.

What to do next

If you've received a surprise medical bill, don’t pay it without reviewing your options. Find an advocate today.