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State Balance-Billing Protections

Last updated on July 31, 2019.

“Balance bills” primarily occur in two circumstances: 1) when an enrollee receives emergency care either at an out-of-network facility or from an out-of-network provider, or 2) when an enrollee receives elective nonemergency care at an in-network facility but is inadvertently treated by an out-of-network health care provider. Since the insurer does not have a contract with the out-of-network facility or provider, it may decide not to pay the entirety of the bill. In that case, the out-of-network facility or provider may then bill the enrollee for the balance of the bill. No federal law currently limits this practice, but 28 states have enacted laws to protect enrollees from it.

See here for the criteria used to determine which states have comprehensive or partial protections.

Select a state to learn how it protects consumers against balance billing

Select a state

Click on a state to learn how it protects consumers against balance billing

PROTECTIONS AVAILABLE

    Notes:

    Source: M. Kona, et al, Center on Health Insurance Reforms, Health Policy Institute, Georgetown University. Please contact Maanasa Kona for questions about this map.
     

    Other resources: 

    Publication Details

    Publication Date: July 31, 2019
    Author: Maanasa Kona

    Experts

    Research Fellow, Center on Health Insurance Reforms, Health Policy Institute, McCourt School of Public Policy, Georgetown University