Illinois · Lab / Pathology
Dispute a lab or pathology at an in-network facility surprise bill in Illinois
NSA protections apply to lab and pathology services performed at in-network facilities by out-of-network providers. In Illinois, additional state-level protections apply.
What the law says
Illinois' Network Adequacy and Transparency Act (215 ILCS 5/356z.3a) prohibits balance billing of insureds for non-emergency services performed at in-network facilities by out-of-network providers and limits the patient's responsibility to the in-network cost-sharing amount. This protection applies in addition to the federal No Surprises Act (42 U.S.C. § 300gg-111 et seq.).
- 215 ILCS 5/356z.3a (Network Adequacy and Transparency Act)
- 42 U.S.C. § 300gg-111 et seq. (No Surprises Act)
Your options
- Dispute the bill in writing before paying anything. The provider must respond and cannot send the bill to collections during the dispute.
- Notify your health insurer that an apparent NSA-protected service has been balance-billed. Ask them to adjudicate at the in-network cost-sharing amount.
- File a complaint with the federal No Surprises Help Desk at CMS if either party refuses to comply.
- If unresolved, you can invoke the patient-provider Independent Dispute Resolution (IDR) process for an external decision.
Other bill types in Illinois
- Emergency room services
- Anesthesiology at an in-network facility
- Radiology at an in-network facility
- Hospitalist services at an in-network facility
Lab / Pathology bills in other states
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