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Surprise Billing

Surprise Billing

Surprise Billing Toolkit

The Ohio Department of Insurance has created a surprise billing toolkit to help consumers, health care providers, health insurers, and other stakeholders understand important consumer surprise billing protections and the law's requirements. Visit the toolkit to access a variety of resources, including answers to frequently asked questions and to make surprise-billing-related complaints to the department.

What is Surprise Billing?

Surprise billing happens when a patient receives an unexpected bill after unanticipated care from an out-of-network health care provider, which can occur at an in-network health care facility such as a hospital, or at an out-of-network health care facility. It can happen for both emergency and non-emergency care. Typically, patients are unaware that the health care provider or health care facility is out-of-network until they receive the bill.

About the Surprise Billing Law

The surprise billing law was created to protect patients from receiving and paying surprise medical bills above the patient's in-network rate from health care providers for emergency care or, in certain circumstances, unanticipated out-of-network care. Cost sharing amounts, which include coinsurance, copayments, and deductibles, are limited to the patient’s in-network amounts.

Before the law, patients were responsible for paying surprise medical bills, oftentimes ranging hundreds to thousands of dollars above the in-network rate, arising from unanticipated out-of-network situations. Price and payment reconciliation is now solely between the patient's health care provider and health insurer.

The law requires the Ohio Department of Insurance to administer and enforce many of the law's provisions. It also gave the department authority to adopt rules to establish the law's operational framework. The department completed this important task, involving stakeholder input, to produce Ohio Administrative Code rule 3901-8-17, which implemented sections 3902.50 to 3902.54 of the Ohio Revised Code.

There is also a federal surprise billing law, called the No Surprises Act, which became effective on January 1, 2022. It is similar to Ohio’s law and will provide Ohioans with additional protections against surprise billing, including for services provided by air ambulances.

Contact Us

If you have surprise billing questions or concerns, you can contact the department at 1-800-686-1526, consumer.complaint@insurance.ohio.gov, and through www.insurance.ohio.gov.