Yes — balance billing is still legal in many states, but recent federal laws and state protections may limit it or ban it entirely depending on the situation. Understanding whether it’s legal in your state requires knowing the type of insurance you have, who treated you, and where the care was provided.
In this guide, we break down what balance billing is, when it’s allowed, when it’s not, and how your state laws affect your rights. We’ll also explain what the federal No Surprises Act covers — and what it doesn’t.
💡 What Is Balance Billing?
Balance billing happens when a healthcare provider charges you the difference between what your insurance pays and what they charge for a service.
Example:
- Provider charges $1,000
- Your insurance pays $600
- The provider sends you a bill for the remaining $400
→ That’s balance billing.
🚫 When Balance Billing Is Illegal (Thanks to the No Surprises Act)
As of January 1, 2022, the No Surprises Act provides nationwide protection against balance billing in certain scenarios:
You CANNOT be balance billed if:
- You receive emergency care from an out-of-network provider or facility
- You are treated at an in-network hospital but are seen by an out-of-network provider (e.g., an anesthesiologist)
- You get air ambulance services from an out-of-network provider
In these cases, providers must accept your insurer’s payment + copay — and cannot bill you for the remainder.
⚖️ When Balance Billing Is Still Legal
You may still be balance billed in these cases:
- Non-emergency care at an out-of-network facility, when you knowingly consent
- Services not covered by your health plan
- When you have short-term, limited-duration insurance, which is not protected by the federal law
- Self-funded employer plans that opt out of federal protection (rare but possible)
In these situations, state law becomes key in determining your rights.
🗺️ Is Balance Billing Legal in Your State?
Some states have strong protections; others have none at all. Here’s a simplified overview (always check your state’s updated statutes):
✅ States With Broad Balance Billing Protections
These states have comprehensive protections covering emergency and non-emergency care, including for both HMO and PPO plans:
- California
- New York
- New Jersey
- Maryland
- Illinois
- Oregon
- Colorado
- Florida
- Connecticut
⚠️ States With Partial Protections
These states protect you in emergency situations only or only if you have an HMO:
- Texas
- Pennsylvania
- Arizona
- Massachusetts
- North Carolina
- Washington
❌ States With Minimal or No Protections
In these states, you may still be balance billed in many non-emergency settings unless the federal No Surprises Act applies:
- Alabama
- Mississippi
- Indiana
- South Dakota
- Georgia
- Oklahoma
🧠 Important: Even in “no protection” states, the No Surprises Act still shields you from surprise emergency billing in most hospital settings.
📃 How to Know If You’re Protected
Step 1: Identify Your Plan Type
- Fully insured plans (purchased through ACA marketplaces or employer-sponsored HMOs/PPOs) → Often protected by state and federal law
- Self-insured employer plans → Usually protected by federal law only
📌 Ask your HR department or check your plan documents to know what kind of insurance you have.
Step 2: Ask the Provider Upfront
Before treatment, ask:
- Are you in-network for my insurance?
- Will I receive any out-of-network services?
- Can you give me a Good Faith Estimate?
📞 What to Do If You Get a Surprise Bill
- Check if the bill is legal
Was it for emergency care or at an in-network hospital? If yes, you may not have to pay. - Call your insurance company
Ask why the service wasn’t fully covered. - Dispute the bill with the provider
Refer to the No Surprises Act and file an internal dispute. - File a federal complaint
Visit cms.gov/nosurprises or call 1-800-985-3059.
🧠 You May Wanna Check Out:
- Denied Coverage for Pre-Existing Conditions? What to Do
Learn your legal options when your insurer won’t cover your pre-existing condition — and how to fight back. - How to Dispute a Medical Bill: Step-by-Step Guide
Use this clear and patient-friendly method to fight unfair or confusing medical charges. - How to Read and Understand a Hospital Bill
Decode the most confusing parts of your hospital statement and spot errors before you pay.
🧾 Final Thoughts: Don’t Pay a Bill You Don’t Owe
Balance billing can catch you off guard — but you have more protections now than ever before. Federal law has your back in many situations, and some states go even further.
🧠 Before you pay that surprise bill, ask questions, check your rights, and dispute anything that feels off. You could save hundreds — even thousands — by knowing what’s legal and what’s not.
