The Commonwealth Fund  |  February 27, 2020

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When a person with health insurance receives services from an out-of-network provider unknowingly, rather than from an in-network provider, it can result in what is called “surprise billing.” Most commonly, this happens during a medical emergency or when a patient inadvertently receives nonemergency services at an in-network facility from an out-of-network provider. When this happens, the insurer may not pay the bill or may pay only a portion of the bill and the out-of-network provider may bill the enrollee for the balance.

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