A bill from a doctor you did not choose

During surgery or a hospital stay, people you never met may care for you. The anesthesiologist. The radiologist who reads your scan. The pathologist who looks at a sample. An assistant surgeon. Each one can send a bill of their own. If they are not in your plan's network, that bill can come as a surprise. With most private health plans, the No Surprises Act limits what these clinicians may bill you for emergency care and for planned care at an in-network hospital or surgery center: usually no more than your in-network share. This page is a summary to help you ask the right questions, not legal advice.

A bill from a doctor you never saw

It is common to get a bill from a clinician you never met. The usual senders are:

• The anesthesiologist, who may have put you to sleep before you were awake to meet them.
• The radiologist, who read your scan from another room.
• The pathologist, who looked at a sample.
• An assistant surgeon.
• An outside lab, which tested a sample taken elsewhere. See a bill from a lab you never visited.

Three checks help:

1. Read the itemized bill. Look for the date of service and the provider's name, and match them with your stay or visit.
2. Find that provider's line on your EOB. Our guide on comparing a bill with an EOB shows where to look.
3. Ask your plan whether the provider was in your network on that date.

Why these bills come

You pick the hospital, or your surgeon does. The hospital usually arranges the other clinicians, not you. Some are not in the same networks as the hospital. Whole departments may be run by outside groups that are not in your plan. So you can choose an in-network hospital and still get an out-of-network bill.

What the No Surprises Act says

This federal law covers most private health insurance, such as plans through a job or the Marketplace. Medicare, Medicaid, TRICARE, VA care and the Indian Health Service have their own protections against some out-of-network bills. The law protects you in two common cases:

• Emergency care, in most cases, even at an out-of-network emergency room.
• Planned care at an in-network hospital, hospital outpatient department or surgery center, when an out-of-network clinician treats you there.

In these cases you should only owe your in-network share: your usual copay, coinsurance and deductible. What you pay counts toward your in-network deductible and out-of-pocket limit.

The consent form rule

For planned care, some out-of-network clinicians can ask you to sign a notice and consent form. Signing it means giving up these protections, and you will likely pay more. Signing is your choice. The form must be given to you on its own, not attached to or hidden in other paperwork.

The timing depends on when the care was booked. Booked at least 72 hours ahead: the form must reach you at least 72 hours before the care. Booked closer than that: you must get it on the day you book, and if the care is that same day, at least 3 hours before it.

Some clinicians are not allowed to ask at all: emergency medicine, anesthesiology, pathology, radiology and neonatology, assistant surgeons, hospitalists, intensivists, and diagnostic services such as lab work. The form also should not be used when no in-network clinician at the facility can give the care, or for urgent needs that come up during the care. In the emergency room you should not get this form either, except in some cases after you are stable.