Out-of-Network Anesthesiologist Surprise Bills

What Is a "Facility-Based Provider"?

💡 KEY DEFINITION: A facility-based provider is a doctor or specialist who works at the hospital or surgical center, not chosen by you. Under the No Surprises Act, these providers CANNOT balance bill you—even if they're out-of-network.

✅ Protected Facility-Based Providers

These providers CANNOT balance bill you if the facility is in-network:

💉 Anesthesiologists - Most common surprise bills ($8K-$35K average)

📊 Radiologists - Reading X-rays, CT, MRI during hospital stay

🔬 Pathologists - Analyzing biopsy/lab samples

🫀 Hospitalists - Hospital-based primary care physicians

🏥 Emergency Medicine - ER physicians and specialists

👨‍⚕️ Assistant Surgeons - Second surgeon you didn't choose

🩺 Consulting Specialists - Called in during your hospital stay

⚠️ NOT Protected (Must Consent)

These providers CAN balance bill with 72-hour notice + written consent:

🔪 Primary Surgeon - You choose your surgeon (with advance notice)

👨‍⚕️ Office Visits - Scheduled appointments at private practice

🏃 Physical Therapy - Outpatient PT at private clinic

💊 Pharmacy - Prescription medications

The #1 Most Common Surprise Bill: Anesthesiologist

Anesthesiologists are the leading cause of surprise medical bills in America. Here's why:

🏥

You Choose In-Network Hospital

You verify hospital and surgeon are in-network. Everything looks good on your insurance website.

💉

Hospital Assigns Anesthesiologist

The anesthesiologist is assigned by the hospital—you have no choice. You don't find out who it is until surgery day.

📄

Anesthesiologist Is Out-of-Network

The anesthesiologist doesn't accept your insurance. They're an independent contractor, not a hospital employee.

💸

Surprise Bill Arrives

Weeks later, you get a $22,400 bill for anesthesia services. Insurance paid $4,200; you owe $18,200 "balance."

🎯 GOOD NEWS: As of January 1, 2022, this scenario is ILLEGAL. The No Surprises Act says if the facility is in-network, ALL facility-based providers (including anesthesiologists) must bill at in-network rates—no exceptions, no waivers.

Real Anesthesiologist Surprise Bill Cases

"I had a routine knee surgery at an in-network hospital. My surgeon was in-network. The anesthesiologist billed $34,800 out-of-network—for 90 minutes of work. Insurance paid $6,200. I was billed $28,600."

Robert K., Age 58

✅ $28,600 Balance WAIVED (No Surprises Act)

"My daughter's appendectomy was emergency surgery. The hospital, surgeon, and ER were all in-network. The anesthesiologist was out-of-network and billed $18,500. We got a collections notice 6 months later."

Tina C., Parent

✅ Bill Reduced to $950 (In-Network Copay)

"I had a C-section at an in-network hospital. The OB, hospital, and pediatrician were all in-network. The anesthesiologist for the epidural was out-of-network: $12,400 bill. I was told I 'should have asked' before surgery."

Angela M., New Mother

✅ $12,400 → $650 (Federal IDR Win)

How to Verify Network Status BEFORE Surgery

Ask Your Surgeon's Office

At least 72 hours before surgery:

📞 "Can you provide the name of the anesthesiologist who will be working on my case?"
📋 "Can you confirm they accept [Insurance Name] as in-network?"
📄 "Can I get this confirmation in writing?"

Call the Hospital Directly

Contact hospital billing department:

🏥 "Are all anesthesiologists at your facility in-network with [Insurance Name]?"
💳 "What is my estimated out-of-pocket cost for anesthesia?"
📝 "Can you send me a pre-authorization for anesthesia services?"
🔍 Get the representative's name and reference number

Verify with Insurance

Call the number on the back of your insurance card:

📞 "Does [Hospital Name] have in-network anesthesia services?"
💰 "What is my copay/coinsurance for anesthesia?"
📋 "Can you pre-authorize anesthesia for procedure code [CPT code]?"
🎫 Request authorization number

Document Everything

Create a verification file:

📝 Names of all representatives you spoke with
📅 Dates and times of calls
🎫 Reference numbers and authorization codes
📧 Email confirmations (request after phone calls)
💾 Save call recordings if your state allows

⚠️ CRITICAL: Even if you can't verify anesthesiologist network status before surgery, you're STILL protected by the No Surprises Act. The law doesn't require you to check—it requires providers to bill in-network if the facility is in-network.

What You Should Pay for Anesthesia

✅ In-Network Anesthesia Cost

$650-$1,500

Your MAXIMUM cost for anesthesia services when facility is in-network:

💰 Typical copay: $500-$750

📊 Coinsurance (20%): $150-$750

✅ Total: $650-$1,500 maximum

🛡️ Protected by federal law

❌ Out-of-Network Anesthesia (ILLEGAL)

$8,000-$35,000

What providers try to charge (NOT LEGAL):

💸 Full billed charges: $8K-$35K

📉 Insurance pays: $2K-$8K

🚫 "Balance" bill: $6K-$27K

⚖️ VIOLATION: $10K penalty

How to Fight an Anesthesiologist Surprise Bill

Verify Federal Protection (30 seconds)

Check all 4 requirements:

✅ Surgery after January 1, 2022
✅ Hospital/facility was in-network
✅ Anesthesiologist out-of-network
✅ No 72-hour written consent signed

If all 4 = YES, you're federally protected.

Send No Surprises Act Letter

Mail to billing provider within 120 days:

📋 State No Surprises Act violation
🏥 Cite facility-based provider protection
💰 Demand reduction to in-network rate
⏱️ Give 30-day response deadline
⚖️ Reference $10,000 federal penalty

File Federal IDR Complaint

If provider doesn't resolve in 30 days:

🌐 www.cms.gov/nosurprises/providers-facilities
💳 $25-$50 filing fee (refunded if you win)
⚖️ Neutral arbiter decides in 30 days
📊 61% patient win rate for anesthesia bills
✅ Provider must accept decision (binding)

Report Violations

File complaints to strengthen case:

🇺🇸 Federal: 1-800-985-3059
🏛️ State Attorney General
📋 State Department of Insurance
💼 Better Business Bureau
📰 Media (local news loves these stories)

Free Sample Dispute Letter

Copy and customize this letter:

[Your Name]
[Your Address]
[Date]

[Anesthesiology Group Billing]
[Address]

RE: No Surprises Act Violation - Balance Billing Prohibited
Patient: [Your Name]
Date of Service: [Surgery Date]
Bill Number: [Number]
Balance Bill Amount: $[Amount]

Dear Billing Department,

I received a balance bill for $[Amount] for anesthesia services during my surgery on [Date] at [Hospital Name]. This bill violates the No Surprises Act (45 CFR § 149.410), which prohibits balance billing by facility-based providers.

FEDERAL PROTECTION APPLIES:
✓ Surgery performed after January 1, 2022
✓ Facility ([Hospital Name]) is in-network with [Insurance]
✓ Anesthesiologist is out-of-network facility-based provider
✓ No 72-hour advance written consent for out-of-network care
✓ Balance bill exceeds in-network cost-sharing amount

FACILITY-BASED PROVIDER STATUS:
As an anesthesiologist providing services at an in-network hospital, you are a "facility-based provider" under 45 CFR § 149.30. The No Surprises Act explicitly prohibits you from balance billing patients when the facility is in-network.

DEMAND:
1. Reduce bill to in-network cost-sharing: $[In-network amount]
2. Waive balance of $[Balance] immediately
3. Remove from collections and credit reporting
4. Provide written confirmation within 30 days

VIOLATIONS SUBJECT TO $10,000 CIVIL PENALTY PER INCIDENT.

If not resolved within 30 days, I will:
1. File federal Independent Dispute Resolution (IDR) complaint
2. Report violation to CMS: www.cms.gov/nosurprises | 1-800-985-3059
3. File complaints with State Attorney General and Department of Insurance
4. Pursue all available legal remedies

Under the No Surprises Act, I owe only my in-network cost-sharing amount. Your balance billing is illegal.

Sincerely,
[Your Signature]
[Your Name]

CC: State Attorney General
    [Insurance Company]
    CMS No Surprises Enforcement

90%

Resolve After Letter

Most providers waive balance bills when cited No Surprises Act

61%

Win Rate via IDR

Federal arbitration heavily favors patients for anesthesia bills

$22,400

Average Bill Reduction

Typical out-of-network anesthesia balance waived

Don't Pay Illegal Anesthesia Bills

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✅ 90% resolve after letter • 💰 Average $22,400 waived • ⚡ 2-minute setup

Anesthesiologist Surprise Bills Are ILLEGAL