Got a surprise medical bill from out of network doctor what can i do

I had my daughter last year at an in-network hospital. My insurance covered everything, and I paid my full deductible.

She was sent to the NICU for an hour for monitoring, and now I’ve received a $3,000 bill from the neonatologist who did a video consult. My insurance says they already paid the hospital for all services, including NICU care, but this doctor is billing me separately as an out-of-network provider.

Is this legal? The bill has now gone to collections. Do I have to pay it, or can I dispute it? Will this affect my credit score?

If this is a medical emergency, call 911. If you’re asking about choosing a plan, check past discussions. If you haven’t included your state and income details, that might help others give better advice. No soliciting allowed.

Check the No Surprises Act—there’s a federal law, and some states have their own versions. This might be covered under those protections, so ask your insurance to review it under the No Surprises Act.

Generally, the law stops out-of-network doctors at in-network hospitals from charging extra, which seems to be what happened here. The fact that it was a video call shouldn’t change that.

You might be dealing with ‘balance billing,’ which the No Surprises Act protects against. Here’s what to do:

  1. Get your explanation of benefits (EOB) from your insurance. It should show the service code (CPT code) and how much your insurance covers.
  2. Check if your insurance was billed. If they were, see if they applied out-of-network benefits. Some plans don’t cover out-of-network care at all.
  3. If the bill is higher than what your insurance allows, this may be illegal under the No Surprises Act. Call the provider and tell them they must bill insurance correctly.
  4. If they refuse, file a dispute with your insurance and report them.

Also, if you can’t pay right now, ask the billing office for a payment plan. That might keep it from hurting your credit.

Did the hospital arrange for this doctor to see your baby? If so, and the hospital was in-network, this should be covered under the No Surprises Act.

Did the doctor bill your insurance? Check your EOB to see what insurance says about the claim. If they denied it as out-of-network, call and ask them to review it under the surprise billing protections.

What state do you live in? Some states have laws that make this illegal, even outside of the federal No Surprises Act.