What out-of-network means
A provider is out-of-network when they don't have a contract with your insurer. Your insurer typically pays less — or nothing — and you may be billed for the difference. This is called balance billing.
The No Surprises Act
Since January 2022, the No Surprises Act limits surprise billing. You cannot be balance billed more than your in-network cost-sharing for emergency services, and non-emergency services from out-of-network providers at in-network facilities in most cases.
If the No Surprises Act appliesYou should receive an Advanced Explanation of Patient Costs before non-emergency services from an out-of-network provider at an in-network facility.
What to check
- Was this an emergency service? NSA protections apply.
- Was the provider at an in-network facility? NSA may limit what you owe.
- Does the balance match your EOB?
General information only. Not legal or medical advice.