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Anesthesiologist Bill After In-Network Surgery

Use the free tool — Surprise Bill Shield

You had surgery at an in-network hospital — then an anesthesiologist bill arrived

You checked that the hospital and the surgeon were in-network. But the anesthesiologist works for a separate group, and that group may not be in your insurance's network. You didn't choose them — the hospital assigned them. Now a bill has shown up for the difference between what they charged and what your insurance paid, and it says "past due."

Federal law: this appears prohibited

Since January 1, 2022, the federal No Surprises Act bans balance billing when an out-of-network provider treats you at an in-network facility — unless you signed a written notice-and-consent form at least 72 hours in advance. For anesthesiology, that consent is not allowed at all, along with emergency medicine, radiology, pathology, neonatology, assistant surgeons, hospitalists, intensivists, and diagnostic services. This applies to employer plans, marketplace plans, and individual plans.

Read the source: CMS — No Surprises Act, your rights.

Florida law backs this up

Florida's balance-billing law also prohibits this. Fla. Stat. 627.64194 covers PPO and EPO plans, and a companion statute covers HMO plans. Both ban balance billing for covered non-emergency services at an in-network facility when the patient had no ability to choose the provider — which describes an anesthesiologist assigned by the hospital.

Read the statute: Fla. Stat. 627.64194.

• If your plan is state-regulated, Florida's Department of Financial Services also takes complaints at 1-877-693-5236.

What you should actually owe

If the No Surprises Act or Florida law applies, you should owe only your in-network cost sharing — the amount shown on your Explanation of Benefits (EOB) that counts toward your in-network deductible. You should not owe the difference between the anesthesiologist's charge and what insurance paid. Keep every EOB; you'll need it.

The letters and the complaint

Don't ignore the bill and don't let it go to collections. Respond in writing before the due date.

• To the provider: state the facts of the care, cite the law, say you will pay only the in-network cost sharing shown on your EOB, and ask them to re-bill your insurer and stop collection.
• To the insurer: ask them to reprocess the claim at in-network cost sharing under the No Surprises Act, and to confirm it in writing.
• If it's not fixed: file with the federal No Surprises Help Desk at 1-800-985-3059, or with the CMS complaint form. See CMS — Submit a complaint. For state-regulated plans, Florida DFS is 1-877-693-5236.

Confirm your situation fits

These protections are for employer, marketplace, and individual plans. If you have Medicare instead, a provider who accepts assignment cannot balance bill you, and one who doesn't is limited to 15% over the approved amount — see Medicare.gov. If you're uninsured, you should have received a Good Faith Estimate and can dispute a bill that's $400 or more above it — see CMS — Good Faith Estimates.

What to do next

Paste the bill — who sent it, what it's for, where the care happened, and what your insurance paid — along with your plan type. The free tool reads your own numbers and tells you whether federal or Florida law likely protects you, what you should owe instead, and gives you the letters to send. No account. Nothing stored.

This is not legal advice and it can be wrong. Confirm with the federal No Surprises Help Desk (1-800-985-3059) or Florida DFS before you rely on it.

Surprise Bill Shield explains the No Surprises Act and Florida balance-billing law in plain language; it can be wrong, and it is not legal advice. Confirm with the CMS No Surprises Help Desk, the Florida Department of Financial Services, or an attorney. Nothing you paste is stored.