What the No Surprises Act Means for Your Breast Health Care

Most of us have been there. You go in for what you think is a routine appointment only to be hit with a medical bill that looks more like a car payment. It’s the kind of bill that makes you wonder if your health insurance is really working for you or just acting as a suggestion box that nobody checks.

The No Surprises Act was supposed to fix that. It was designed to protect patients from unexpected bills when they get emergency care or certain services at an in-network hospital but from an out-of-network provider. Sounds great, right? But when it comes to breast health — especially diagnostic imaging, biopsies or surgery — the law can still leave you exposed.

Let’s say you get called back after a screening mammogram. You go in for a diagnostic mammogram or an ultrasound. Those aren’t considered preventive care anymore, which means your $0 balance just turned into “surprise, that’ll be $300.” And here’s the kicker — even if the facility is in network, the radiologist reading your images might not be.

Or maybe your imaging leads to a biopsy. You’re stressed, you’re overwhelmed, and you’re trusting your provider to guide you. What no one tells you is that the pathologist who examines your tissue could be out of network. That means you could get a separate bill that doesn’t fall under your in-network benefits, all while you’re just trying to find out if you have cancer.

Now let’s go further. Maybe you do get diagnosed. You plan surgery with your in-network breast surgeon at an in-network hospital. But anesthesia, surgical assistants, and post-op radiology? All of that can be billed separately. And if even one of those is out of network, the protections under the No Surprises Act only apply in specific situations. If the service wasn’t an emergency, or if you signed paperwork giving consent — possibly without knowing what you were agreeing to — the protection can disappear.

And if you're thinking this only matters for breast cancer patients, think again. Even someone getting a follow-up for dense breasts or a suspicious lump that turns out to be benign can get stuck in the same billing trap. Any step beyond a basic screening can trigger costs you didn’t plan for.

The law does give you some rights. If you're at an in-network facility, you’re generally protected from being charged out-of-network rates for emergency services or certain non-emergency services from out-of-network providers. But the language is full of exceptions, and not every provider plays by the rules.

What can you do? Ask questions before you get care. Specifically, ask whether every provider involved is in network — not just the facility. If you’re getting imaging, ask about the radiologist. If you’re having a biopsy, ask who’s reading the results. If you’re heading into surgery, get clarity on anesthesia, pathology, and any assistant surgeons. It’s not always easy, and it shouldn’t be on you, but until transparency becomes the norm, being proactive is your best protection.

No one should have to fight their insurance company while they’re managing their health. And no one should get stuck with surprise bills just because they trusted their doctor. Whether you’re navigating a diagnosis or just staying on top of your breast health, you deserve care that’s affordable, honest, and without hidden landmines.

It’s your body. It’s your money. You should get to understand both before the bills show up.