How to Handle Surprise Medical Bills After Birth and What the No Surprises Act Covers

December 19, 2025
4:48 am

By Jennifer Jane

That surprise bill you got from an anesthesiologist you met for five seconds when you were in labor? There is a law to shield you from that. The No Surprises Act is the law that protects you from getting surprise bills from out-of-network providers, like anesthesiologists or radiologists, at an in-network facility.

Let’s go through what the No Surprises Act does, what it doesn’t do, and how tools on Lyvona.com can help.

What is a surprise bill?

Commonly, before 2022, a surprise bill for new moms who delivered at an in-network hospital could come from a provider on their care team (an anesthesiologist, neonatologist, or another specialist) who was unknowingly out of network. That doctor could then “balance bill” parents for the difference between what they charged for their services and what their insurance paid. Most of the time, parents had no idea that the provider was out-of-network until they received the bill (1).

In a large 2019 study of people with private insurance, almost 1 in 5 families who had births at in-network hospitals got hit with surprise bills, and for one-third of those families, the extra charges were over $2,000 (2).

What the No Surprises Act does

The No Surprises Act (NSA) took effect January 1, 2022. It sets federal rules that:

Ban surprise bills (balance billing) in the most common situations.
Limit your costs to what you would have paid in-network.
Keep you out of the fight between the hospital/provider and the insurance company — there is a formal dispute process to discuss payment without you being involved.
Require that providers and hospitals give you an easy-to-understand notice explaining the billing protections, who to contact if you’re concerned that a provider has violated the protections, and that you must receive notice of and consent to being balance billed by an out-of-network provider (3).

For a typical labor and birth, this is what that could mean for you:

You’re protected from surprise bills when:

You need emergency care. If you show up in labor at an out-of-network emergency room or end up transferred to an out-of-network hospital, you can’t be balance billed for emergency services. You pay your in-network cost-sharing (copay, deductible, coinsurance, as applicable); the rest is between your plan and the hospital/doctors (3).
You’re at an in-network hospital, but someone on your care team is out-of-network.
For non-emergency care at an in-network hospital, out-of-network providers generally can’t balance bill you for covered services that are part of that visit. This includes specialists such as:

Anesthesiologists
Radiologists
Pathologists
Neonatologists
Assistant surgeons

These are considered ancillary services under the law, and providers can’t ask you to sign away your protections for them.
The claim is treated as if it were in-network. When the NSA applies, your cost-sharing must be calculated as if the provider were in-network, and the amount you pay must count toward your deductible and out-of-pocket max (3).

Where the law doesn’t apply:

Out-of-network facility by choice.
If you knowingly choose an out-of-network hospital or birth center for a non-emergency delivery, the NSA doesn’t rescue you from higher bills (4).
Most ground ambulances.
Ground ambulance rides are usually not covered by the federal law (3).
Notice-and-consent forms.
For some non-emergency care, out-of-network providers can ask you to sign a special form to waive protections. But they cannot do this for anesthesia or emergency care (3).

How to lower your chances of a surprise bill during birth

You can’t control everything about labor, but you can help avoid some problems:

1. Confirm your obstetrician, hospital, and insurance plan

Ask your obstetrician which hospital or birth center they deliver at.

Call your health insurance to

Confirm that the hospital is in-network for your specific plan.
Ask if the anesthesia group that covers labor and delivery is in-network.
Ask if the anesthesiologist is out of network at an in-network hospital, do you still only owe in-network cost sharing under the No Surprises Act?
Ask them to send that in writing or via secure message (3).

If anyone hands you a stack of forms to sign while you’re pregnant, ask whether any of them waive your No Surprises Act protections. You can say you’re not comfortable signing any waiver related to surprise billing.

2. Use Lyvona as your cost partner

Lyvona is built specifically around pregnancy and postpartum costs, not general healthcare. It can help you:

Model your costs for different scenarios (vaginal birth vs C-section, December vs January delivery, etc.) using its cost modeling tools and deductible calculator.
See how other moms were billed for labor, epidurals, and newborn care with your type of insurance, so unexpected bills are easier to spot.
Upload bills for review so errors and questionable out-of-network charges get flagged before you pay.
Talk through strategy with other moms and a moderated, pregnancy-specific community focused on cost transparency.

What to do if you still get a surprise bill after birth

Take it step by step.

Step 1: Compare the bill to your Explanation of Benefits (EOB)

Look for that specific charge on your EOB from your insurance (this is not a bill; it’s a benefits summary).
Check if the provider is listed as out-of-network, but the hospital you delivered at is an in-network hospital. That’s the kind of scenario the NSA is meant to cover (3).

Step 2: Call your health plan

Say something like this:

“I delivered my baby at an in-network hospital. This bill is from an out-of-network anesthesiologist. Under the No Surprises Act, my cost-sharing should be at in-network levels, and I shouldn’t be balance billed. Can you reprocess this claim under the No Surprises rules?”

Ask them to:

Confirm whether the NSA applies in your situation
Reprocess the claim if they processed it incorrectly
Send you updated documentation showing your correct responsibility

Step 3: Call the provider’s billing office

Call the anesthesiology group or hospital billing department:

Tell them you believe the No Surprises Act applies.
Ask them to pause collections while your insurer reprocesses the claim.
Request a revised bill that reflects in-network cost-sharing only, once the insurance side is fixed (5).

This is a good moment to lean on Lyvona’s bill-review features and community for help decoding the jargon and planning what to say on the phone.

Step 4: If you were given a Good Faith Estimate and the bill is higher than expected

If you’re uninsured, self-pay, or choose not to use insurance, you should receive a Good Faith Estimate (GFE) before receiving care. If your final bill is $400 or more above that estimate, you can use the patient–provider dispute resolution process set up under the NSA (6).

Key points:

You generally have 120 days from the date of the bill to start the dispute (6).
There’s a fee (around $25) to file (7).
While the dispute is active, collection efforts are supposed to pause (8).
The disputed charges will be reviewed and a binding determination will be issued within 30 business days of receiving the necessary documentation (8).

Step 5: Use the No Surprises Help Desk and complaints process

If the bill still looks wrong, or you think your protections are being ignored, you can get outside help:

No Surprises Help Desk (federal): 1-800-985-3059
Online complaint form via the federal “medical bill rights” site.

They can help you figure out whether the No Surprises Act should protect you in your particular situation, explain next steps, and direct your complaint to the right state or federal agency. This isn’t legal representation, but it is a real enforcement channel.

How Lyvona helps if you’ve received surprise bills:

Consider Lyvona the nerdy friend who likes reading EOBs and helps you work out problems you’d rather avoid:

You can upload your hospital and anesthesia bills, and Lyvona’s tools help flag possible errors, duplicate charges, and suspicious out-of-network billing.
You can get support from communities of other pregnant and postpartum moms dealing with similar surprise-bill scenarios.
Lyvona’s focus on pregnancy-specific cost traps like double deductibles, separate newborn bills, and surprise providers means they’re tuned into the situations that often lead to No Surprise Act-relevant billing problems.

Sources:

https://www.magmutual.com/healthcare-insights/article/understanding-part-ii-of-the-no-surprises-act-dispute-resolution-and-good-faith-e

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