Balance Billing
What it means
Balance billing happens when an out-of-network doctor or provider charges a patient for the difference between their full price and what insurance paid. For example, if the doctor charges $5,000 and insurance pays $2,000, the doctor sends the patient a bill for $3,000. New York's Surprise Bill Law (Financial Services Law Section 603) protects patients from balance billing during emergencies and other situations where the patient had no choice of provider. Under the law, the patient only pays the in-network amount. The doctor and the insurance company work out the rest between themselves.
When you might hear this
You hear this when you go to the emergency room and later get a bill from a doctor you did not choose. The doctor was not in your insurance network, and the bill is the difference between what your insurance paid and what the doctor charged.
What to ask
- Was the provider in my insurance network?
- Does this bill fall under the Surprise Bill Law?
- Is the amount on this bill my in-network share or the full out-of-network charge?
- How do I file a complaint about a surprise bill?