Quick answer
First, check whether federal law protects you. The No Surprises Act bans most surprise bills for emergency care, air ambulances, and out-of-network doctors at in-network hospitals and surgery centers. If your bill isn’t covered by those protections, ask your insurer to review it, file an appeal if it was denied, ask the provider for an itemized bill and a discount, and ask about financial assistance or a payment plan before you pay.
Key takeaways
- Out-of-network care usually costs more, and HMO and EPO plans may not cover it at all.
- For protected surprise bills, you only owe your in-network cost-sharing.
- Ground ambulance rides aren’t covered by the federal law, though some states protect you.
- You can appeal, negotiate, ask for financial assistance or set up a payment plan.
- The best defense is checking network status before scheduled care.
On this page
Why out-of-network care costs more
In-network providers agree to discounted rates with your insurance company. That discount is a big part of what insurance does for you. Out-of-network providers haven’t agreed to those rates, so:
- HMO and EPO plans usually pay nothing except for emergencies. See what is an EPO plan.
- PPO and POS plans pay a smaller share, often with a separate, higher deductible.
- The provider can bill you for the difference between its charge and what your plan pays, called balance billing, unless the law protects you.
- What you pay out of network may not count toward your in-network out-of-pocket maximum.
This works the same way at every metal level; see bronze, silver, gold and platinum plans.
When federal law protects you
| Situation | Protected by the No Surprises Act? |
|---|---|
| Emergency care at any hospital or freestanding emergency room | Yes. You pay in-network cost-sharing |
| Care after you’re stabilized in an emergency | Yes, unless you’re stable enough to transfer and you sign a consent form waiving your protections |
| Out-of-network doctors at an in-network hospital or surgery center, like anesthesiologists, radiologists, pathologists and assistant surgeons | Yes |
| Air ambulance | Yes |
| Ground ambulance | No, though some states have their own protections |
| Scheduled care you chose from an out-of-network doctor or hospital | No |
When you’re protected, what you pay counts toward your in-network deductible and out-of-pocket maximum. A trip to an out-of-network emergency room, for example, costs you the same as an in-network one. If you’re admitted, see does health insurance cover long hospital stays.
How to avoid out-of-network bills
- Check that every provider is in network, including the facility, lab and imaging center.
- Before scheduled surgery, confirm the hospital or surgery center is in network. That’s what protects you from bills from doctors you don’t pick, like the anesthesiologist.
- Read what you’re asked to sign. A “notice and consent” form lets an out-of-network provider bill you more. You don’t have to sign it, and you can ask for an in-network provider instead. Emergency, anesthesia, radiology, pathology and lab providers can’t ask you to sign one.
- Fill prescriptions at in-network pharmacies. See does health insurance cover prescription drugs.
- If your network has no specialist who can treat you, ask your plan for an exception before you get care.
What to do with an out-of-network bill
- Compare the bill with your explanation of benefits. Make sure the claim was processed correctly and with the right network status.
- Check whether it’s a protected surprise bill. If it is, you only owe your in-network cost-sharing. Tell the provider and your insurer. If they don’t fix it, call the No Surprises Help Desk at 1-800-985-3059.
- Appeal. If your plan denied or underpaid the claim, file an internal appeal, then ask for an external review if that fails. See how to appeal a health insurance claim denial.
- Ask for an itemized bill and question charges you don’t recognize.
- Negotiate. Ask the provider to accept your plan’s rate or offer a discount for paying promptly.
- Ask about financial assistance. Nonprofit hospitals must have financial assistance policies, and many cover middle-income patients.
- Set up a payment plan for what’s left. Many providers offer interest-free plans.
A medical billing advocate can handle this for a fee. Paying your own way can work for small, predictable costs, but big out-of-network bills show the risk; see what if you can afford your medical bills out of pocket.
Want a plan with a network that fits your doctors? Compare quotes by ZIP code.
Frequently asked questions
Does out-of-network care count toward my out-of-pocket maximum?
Usually not when you chose an out-of-network provider. For protected surprise bills, your in-network cost-sharing counts toward your in-network deductible and out-of-pocket maximum.
Can a hospital make me give up my protections?
For some scheduled care, an out-of-network provider can ask for your written consent to bill you more. You can say no. Emergency, anesthesia, radiology, pathology and lab providers can’t ask at all.
Are ambulance rides covered by the No Surprises Act?
Air ambulances are. Ground ambulances aren’t, though some states limit those bills.
What if I don’t have insurance?
You have a right to a good faith estimate for scheduled care. If the final bill is at least $400 more than the estimate, you can dispute it.
Sources
This article is general information, not legal or insurance advice. Your rights depend on your plan and your state. Last reviewed September 2026.