What Is Surprise Billing?

Surprise billing occurs when a patient receives an unexpected medical bill, often after unknowingly receiving care from an out-of-network provider. This can happen in emergencies or when receiving treatment at an in-network facility where certain providers (such as anesthesiologists or radiologists) are out-of-network.

Why is surprise billing a problem?

• Unexpected costs: Patients may assume they are covered, only to receive large out-of-network bills later.
• Limited patient control: In emergencies, patients may not have a choice in selecting an in-network provider.
• Balance billing risk: Some providers bill patients for the difference between what insurance covers and their total charges.

Protections Against Surprise Billing

• No Surprises Act (2022): Federal law limits out-of-network charges for emergency services, air ambulance transport, and certain non-emergency care at in-network facilities.
• Medicare & Medicaid: These programs protect beneficiaries from most forms of surprise billing, though gaps can still occur.
• State laws: Some states provide additional protections beyond federal regulations.

How Solace can help

A Solace advocate can help you understand your bill, dispute unexpected charges, and determine whether surprise billing protections apply to your situation. They can also help negotiate medical costs, find financial assistance programs, and craft appeals for denied claims.

What to do next

Need help with a medical bill you weren’t expecting? Find an advocate today.