Surprise $14,000 bill after surgery - hospital used out-of-network anesthesiologist without telling me

Had knee surgery last month at an in-network hospital with an in-network surgeon. Everything was pre-approved by insurance. Got home, thought I was done.

Then yesterday I get a bill for $14,200 from some anesthesiology group I've never heard of. Turns out they were out-of-network. I had NO choice in this - I was literally unconscious when they provided services!

My insurance says I'm responsible for the balance after they paid their "usual and customary" amount of $1,800. The anesthesiologist billed $16,000 total.

How is this legal? I'm in California if that matters. I specifically chose an in-network hospital to avoid this exact situation.

This is EXACTLY what the No Surprises Act was designed to prevent. If your surgery was after January 1, 2022, you should be protected from balance billing for out-of-network emergency services and certain non-emergency services at in-network facilities.

Anesthesiology is specifically called out in the law as a covered ancillary service. You should NOT have to pay that $14,200.

Healthcare attorney here. The No Surprises Act (NSA) specifically covers ancillary services like anesthesiology at in-network facilities. Under the law:

• You should only owe your in-network cost-sharing amount (deductible, copay, coinsurance)
• The provider cannot balance bill you for the difference
• The provider and insurer have to work out payment between themselves through an Independent Dispute Resolution (IDR) process

Since you're in California, you also have additional protections under California's AB 72 (the state's balance billing law that actually predates the federal NSA).

Send the anesthesiology group a letter citing both the No Surprises Act and California Health & Safety Code Section 1371.9. State that you dispute the balance bill and will only pay your in-network cost-sharing amount.

Thank you both! I had no idea about the No Surprises Act. When I called the anesthesiology billing department, they were very aggressive about the bill being valid and said I "should have verified all providers before surgery."

How was I supposed to do that?? The hospital assigned the anesthesiologist, not me!

What if they send this to collections?

That's a scare tactic they use. Here's what you should do:

1. Send a written dispute letter via certified mail citing the No Surprises Act
2. File a complaint with CMS (Centers for Medicare & Medicaid Services) at cms.gov/nosurprises
3. File a complaint with the California Department of Managed Health Care
4. Also notify your insurance company that the provider is attempting to balance bill you illegally

The provider can face penalties of up to $10,000 per violation for illegal balance billing under the NSA. Once they realize you know your rights, they usually back off quickly.

Anesthesiologist here (not involved in this case obviously). This is unfortunately common with some contract anesthesia groups. They know the NSA prohibits this, but they count on patients not knowing their rights.

Many of us in the field are embarrassed by these practices. The hospital should also bear some responsibility - they contract with these groups and should ensure compliance.

One thing to check: Did you sign anything before surgery that mentioned waiving balance billing protections? Some shady providers try to get patients to sign waivers. Under the NSA, any such waiver for ancillary services like anesthesia is generally not valid.

I went back through my paperwork and I did sign a general consent form, but nothing specifically about waiving balance billing or agreeing to out-of-network charges for ancillary services.

I'm drafting the dispute letter now. Should I cc anyone specific?

Good - a general consent form is not a valid NSA waiver. For a waiver to be valid (in the limited circumstances where waivers are even allowed), there are very specific requirements including 72-hour advance notice and a specific waiver form.

For your letter, I'd cc:

• Your insurance company's member services
• The hospital's patient advocacy department
• California Department of Managed Health Care (reference in letter that you're filing complaint)

Also explicitly state in your letter that you are disputing the debt under the Fair Debt Collection Practices Act and that any attempt to collect the disputed amount or report it to credit bureaus will be considered a violation of federal law.

I went through something very similar last year - $8,500 balance bill for an out-of-network assistant surgeon I never met or approved. Same situation, in-network hospital and primary surgeon.

Sent a dispute letter citing the NSA, filed complaints with CMS and state, and cc'd my insurance. The billing company sent me one more threatening letter, then went silent. Three months later I got a letter saying the balance was "resolved" and I owed nothing.

Stand your ground!

Word of warning: some of these medical billing companies are relentless. Even if you dispute, they might still try to send to collections. If that happens, dispute with the collection agency IN WRITING within 30 days and cite the NSA.

Also keep copies of everything. Every letter, every email, notes from every phone call with date/time/name of person you spoke to.

Quick mod note: We've had several threads on surprise medical billing lately. For anyone reading this, here's a summary of key resources:

• CMS No Surprises Help Desk: 1-800-985-3059
• File complaints at: cms.gov/nosurprises
• California DMHC: dmhc.ca.gov (for state-regulated plans)
• California CDI: insurance.ca.gov (for federally-regulated plans)

OP, please update us on how this resolves!

UPDATE: Sent the certified letter on Oct 18. Filed complaints with CMS and California DMHC on Oct 19.

Just got a call from the anesthesiology group's billing department. Completely different tone this time. They said they're "reviewing" my case and asked me to disregard the previous bill. The person actually apologized!

I asked for everything in writing and they said they'd send a letter confirming the balance is being adjusted. Will update when I get that.

This is the typical pattern. They try to bully patients into paying, and the moment someone pushes back with actual legal citations, they fold.

Make sure that letter explicitly states the account balance is $0 and that nothing will be reported to credit bureaus. Don't accept vague language like "balance adjusted" without a specific amount.

RN here. This happens way more than people realize. I always tell my patients to ask specifically about ALL providers who will be involved in their care BEFORE any procedure. But honestly, that's putting an unfair burden on patients - the system should protect people automatically.

Glad the NSA is working as intended here. Before that law, patients had almost no recourse.

FINAL UPDATE: Got the letter today! It says:

"After review, your account has been adjusted to reflect your in-network cost-sharing responsibility only. Your new balance is $247.50 (representing your plan's coinsurance). The previous balance of $14,200 has been removed. This account will not be reported to any credit reporting agency."

$247.50 vs $14,200 - I'll take that any day! Thank you everyone for the guidance. The No Surprises Act actually works, but only if you know about it and fight back.

Excellent outcome! This is exactly how the law is supposed to work. Keep that letter forever - scan it and save it in multiple places.

For others reading this: the No Surprises Act is one of the most significant consumer protection laws in healthcare in decades. Know your rights!