Why did I get a bill from an out-of-network doctor at an in-network hospital?

Some clinicians at an in-network facility may not be in your network. The No Surprises Act protects against many of these bills for non-emergency care at in-network hospitals and surgery centres; see CMS’s medical bill rights page.

In network vs out of network

Your plan’s network is the facilities, providers, and suppliers it has contracted with. Staying in network is usually the single biggest thing you can do to keep costs predictable.

Last reviewed against MedlinePlus, HealthCare.gov, and CMS pages linked on this page on October 22, 2026.

The difference

The difference
	In network	Out of network
Contract with your plan	Yes, at agreed (“allowed”) amounts	No
Your share	In-network copay or coinsurance	Usually higher out-of-network coinsurance — or no coverage, depending on the plan type
Balance billing	A preferred (network) provider may not balance bill you for covered services	The provider may bill you the difference between their charge and the allowed amount, unless the No Surprises Act applies

From HealthCare.gov glossary definitions of network, out-of-network coinsurance, and balance billing.

Balance billing, with HealthCare.gov’s example

If a provider charges $100 and your plan’s allowed amount is $70, an out-of-network provider may bill you the remaining $30. That is balance billing. For emergency care and some care at in-network facilities, the No Surprises Act limits it.

Checking before you go

Look the provider up in your insurer’s directory
Call the office and ask whether they are in network for your specific planName the plan, not just the insurer.
Ask about everyone involvedLabs, imaging, and anesthesiologists can bill separately.
Ask whether a referral or prior authorization is needed

Common questions

Why did I get a bill from an out-of-network doctor at an in-network hospital?: Some clinicians at an in-network facility may not be in your network. The No Surprises Act protects against many of these bills for non-emergency care at in-network hospitals and surgery centres; see CMS’s medical bill rights page.

Sources

Network (glossary) (opens in a new tab) — HealthCare.gov (CMS)
Out-of-network coinsurance (glossary) (opens in a new tab) — HealthCare.gov (CMS)
Balance billing (glossary) (opens in a new tab) — HealthCare.gov (CMS)
Medical bill rights (No Surprises Act) (opens in a new tab) — Centers for Medicare & Medicaid Services (CMS)

Questions about this page

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Last reviewed against MedlinePlus, HealthCare.gov, and CMS pages linked on this page on October 22, 2026.

Definitions and rules on this page come from the sources listed. If one has changed, tell us and we will correct it.