Balance Billing: How Are States Protecting Consumers from Unexpected Charges?

Large bills from an out-of-network health care provider can be an unexpected surprise to consumers who did not knowingly obtain health care outside the plan’s provider network. As health plans embrace tighter networks as a tool for improving quality or reducing premiums, the potential for such bills may grow. Although insurers may protect their plan members in some cases, there is no broad protection from these types of bills in federal law or in most states. Several states have acted to protect consumers from the need to pay balance bills, at least in emergency situations. But even these states have struggled with how to implement protections while balancing legitimate interests of health plans and health care providers. This issue brief summarizes and compares seven state approaches to protecting consumers from balance billing.