Surprise Bills from Anesthesiologists: Why They Happen and How to Fight Them

You chose an in-network hospital and an in-network surgeon. Then a bill arrived from an anesthesiologist you never met and never chose, for thousands of dollars. This is one of the most common surprise billing scenarios in American healthcare, and you have specific rights to fight it.

Why anesthesiologist surprise bills happen

Most hospitals employ or contract with anesthesiology groups independently from their main physician network. Your insurer may have contracts with the hospital and the surgeon but not with the anesthesiology group. Until 2022, this left patients legally responsible for the difference between what their insurer paid and what the anesthesiologist billed.

The No Surprises Act changed that for most situations. Since January 2022, patients receiving care at in-network facilities cannot be balance billed by out-of-network providers for emergency care or for non-emergency care when they did not have a meaningful choice of provider.

Anesthesia is the clearest example of no meaningful choice. You cannot select your anesthesiologist in advance for most procedures. You do not have a pre-procedure conversation with them. You are sedated when they provide care. The law was largely written with this scenario in mind.

What the No Surprises Act covers

For procedures at in-network facilities, out-of-network anesthesiologists cannot bill you more than your in-network cost-sharing amount. They cannot send you a balance bill for the difference between their charge and what your insurer paid.

There is one exception. If you sign a written consent form acknowledging you are voluntarily choosing an out-of-network provider for non-emergency care and waiving your protections, the balance billing prohibition can be waived. This waiver is not valid for ancillary providers like anesthesiologists, radiologists, and pathologists, whose services are inherently not a patient choice.

If you received a consent form at admission, review it carefully. A consent form for treatment is not a waiver of your balance billing rights. A waiver must specifically describe the estimated out-of-network cost and must be signed voluntarily, not as a condition of receiving care.

What to do when you receive the bill

Do not pay it immediately. Contact your insurer first and ask them to verify whether the anesthesiologist was out-of-network and whether the No Surprises Act applies to your situation. Your insurer has an obligation to process the claim at your in-network cost-sharing rate if the law applies.

If your insurer agrees the No Surprises Act applies, they should reprocess the claim and send the anesthesiologist the correct payment. You pay only your in-network deductible, copay, or coinsurance.

If the anesthesiologist continues billing you after your insurer has processed the claim correctly, send a written dispute referencing the No Surprises Act (42 CFR Part 149) and stating that you are not responsible for amounts above your in-network cost-sharing obligation.

Filing a complaint

If the provider refuses to comply or your insurer is not enforcing your rights correctly, file a complaint with the federal No Surprises Help Desk at 1-800-985-3059 or online at cms.gov. You can also file with your state insurance commissioner if your state has its own balance billing laws.

Document everything. Keep the original bill, all correspondence, your insurer's explanation of benefits showing in-network processing, and records of any phone calls including dates and representative names.

Checking before your procedure

Before any scheduled procedure at an in-network facility, call your insurer and ask specifically whether the anesthesiology group contracted with that hospital is in-network. If they are not, ask your insurer for a list of in-network anesthesiologists and request one of them in writing to your surgeon.

Even if the No Surprises Act would protect you after the fact, preventing the billing problem entirely is preferable to disputing it after surgery.

---

Bill Advantage is a document literacy tool. Nothing in this article constitutes legal or medical advice.