Glossary · Definition · v2026.3
Balance Billing
Balance billing occurs when a healthcare provider bills a patient for the difference between the provider's charge and the amount the insurance company paid. In many emergency situations, this practice is restricted under the No Surprises Act.
How it happens
Balance billing most commonly occurs when patients receive care from an out-of-network provider, often without knowing the provider was out of network. This is especially common with anesthesiologists, radiologists, and emergency room physicians who may be contracted separately from the hospital.
Patient protections
The No Surprises Act, effective January 2022, protects patients from balance billing in many emergency situations and when receiving care from out-of-network providers at in-network facilities. Patients who receive a balance bill in these situations can dispute it.
Related reference
Used in
This content defines terminology for educational orientation. It does not constitute medical advice.
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