Avoiding Out-of-Network Surprise Lab Bills: What Patients and Providers Should Know
Despite introducing the No Surprises Act (NSA) in 2022, many Americans still face surprise bills, especially for out-of-network (OON) laboratory services. In the first half of 2024 alone, CMS received over 16,000 complaints related to surprise medical bills, with a significant portion stemming from OON lab charges and inaccurate cost estimates.
In this blog, we’ll explore why OON lab billing remains a persistent problem despite the NSA, how healthcare providers can improve their billing practices to prevent these surprises, and what steps patients can take to avoid being caught off guard.
How the No Surprises Act Affects Patients and Lab Billing
The No Surprises Act (NSA) was designed to protect patients from unexpected medical bills, especially from out-of-network (OON) providers during emergencies or at in-network facilities.
However, the protections don’t always apply to independent labs and outpatient clinics, creating a major gap in coverage. Even routine checkups can lead to costly surprises, confusing and financially stressful patients.
In fact, a study found that 43% of patients receive inaccurate cost estimates for lab work. It’s no surprise that over 670,000 billing disputes were filed in 2023 alone.
These surprise bills can also cause stress, lead patients to delay care, and erode trust in the healthcare system. Nearly 1 in 3 Americans skipped care in 2023 due to cost concerns, many linked to unexpected charges.
Why do surprise lab bills still happen?
- Lab services are often used without verifying insurance coverage in advance.
- Labs typically bill separately from doctors or hospitals.
- Patients are rarely told their lab work is being sent out-of-network.
The solution? Greater transparency, proactive verification, and better communication between providers, labs, and patients.
Strategies to Handle Out-of-Network Lab Billing
Surprise lab bills can frustrate patients and cause administrative stress for healthcare teams. Avoiding them requires effort from both sides. To reduce the risk of surprise bills, patients and providers must take proactive, informed steps.
For patients:
For healthcare providers:
These steps help reduce surprise costs, build patient trust, and ensure smoother billing operations.
Case in Focus: How Lab Billing Expertise Rescued Complex OON Claims
Even with the proper steps, billing for OON labs is complex and demands precision. That’s where Synapse’s billing team made a powerful impact.
A diagnostic lab client saw a 60% increase in average payments and a 52% rise in average charges by year-end, simply by improving their approach to OON claims.
Here’s how the Synapse team made it happen:
- Medical billers matched every test accurately with a valid, covered diagnosis using up-to-date CPT and ICD codes.
- The team contacted labs directly before submission when diagnosis information was missing, preventing costly denials.
- A dedicated collections team responded swiftly to insurer requests, which is essential for complex OON scenarios.
- Strong software systems helped track submissions and flag errors early, improving turnaround and reducing delays.
This case shows that with the right transparency, expertise, and systems in place, OON billing doesn’t have to be a burden—it can be an opportunity for growth and better patient outcomes.
Transparent Lab Billing Made Simple with Synapse
Synapse Lab Billing empowers providers to verify coverage early, inform patients clearly, and submit compliant claims that minimize denials and disputes.
Our core services bring visibility and efficiency to every stage:
- Lab coding: Accurate, audit-ready coding that reduces errors and improves reimbursement.
- Collections management: Full-cycle claim handling with real-time updates and clear communication.
- Credentialing support: Hassle-free enrollments and renewals, with status tracking so you’re always informed.
Don’t leave lab billing revenue on the table. Partner with Synapse to streamline billing, improve compliance, and maximize reimbursement. Schedule a FREE demo to see how Synapse can transform your lab’s financial performance.
Sources:
No Surprise Billing; Lifted from
https://www.cms.gov/nosurprises
What is a “surprise medical bill,” and what should I know about the No Surprises Act?; Lifted from
https://www.consumerfinance.gov/ask-cfpb/what-is-a-surprise-medical-bill-and-what-should-i-know-about-the-no-surprises-act-en-2123/
AHA Report 2023; Lifted from
https://www.ahajournals.org/doi/10.1161/CIR.0000000000001309
How many people skip medical treatment due to healthcare costs?; Lifted from
https://usafacts.org/articles/how-many-people-skip-medical-treatment-due-to-healthcare-costs/
Cost of caring; Lifted from
https://www.aha.org/costsofcaring#:~:text=Hospital%20Expenses%20are%20Growing%20Faster,among%20patients%20with%20chronic%20conditions.
Understanding the billing processes of Out-of-Network laboratory services;
https://www.needle.tube/resources-articles/understanding-the-billing-process-for-out-of-network-laboratory-services-with-insurance-companies
Frequency and Costs of Out-of-Network Bills for Outpatient Laboratory Services Among Privately Insured Patients; Lifted from
https://pmc.ncbi.nlm.nih.gov/articles/PMC8077039/