Two anesthesia bills probably won’t be the same, and seeing two can seem like a double charge. This can warrant further investigation, but in most cases, they’ll provide information about distinctly different parts of the anesthesia service. They can also have different billing providers.
 Anesthesia billing can be confusing compared to other billing services because anesthesiologists can be employed by companies that are separate from the hospitals. Also, Certified Registered Nurse Anesthetists (CRNAs) can provide care for the patient. Sometimes, even if the surgeon is in network and employed by the hospital, the anesthesia provider can be with an out-of-network practice.
 When you receive two anesthesia bills, the first thing you should do is find out who issued the bill, what the service is, how your insurance has processed the bill, and whether the surprise-billing protections have been triggered.
Why Is Anesthesia Billed Separately From the Hospital or Surgeon?
One procedure can involve several independent healthcare entities.
Your surgeon bills for performing the procedure. The hospital or ambulatory surgery center may bill for the operating room, nursing staff, equipment, supplies, and facility services. The anesthesia group may submit its own professional claim.
That means receiving separate bills after one surgery does not automatically mean duplicate billing.
A typical surgical encounter might generate separate claims for:
- the surgeon;
- the hospital or surgery center;
- the anesthesia provider;
- pathology or laboratory services;
- radiology or other specialists involved in your care.
The anesthesia practice may simply contract with the hospital rather than being owned by it. That is why paying your hospital bill does not necessarily mean the anesthesia professional has already been paid.
Why Would I Receive Two Anesthesia Bills?
The anesthesiologist and CRNA may be billed separately
Many cases of anesthesia use both an anesthesiologist and a CRNA (Certified Registered Nurse Anesthetist).
Depending on the structure of the anesthesia care team and the particular insurance company’s requirements for filing claims, the physician and CRNA may each appear on separate claims.
There are several types of anesthesia billing arrangements recognized by Medicare. For example, different modifiers indicate an anesthesiologist performing an end of the case anesthesia service, physician medical direction, and CRNA services with or without medical direction.
Therefore, two provider names on a claim for anesthesia does not necessarily indicate that a claim was double billed.
Two anesthesia professionals may have been medically necessary
In less common, high-acuity cases, two anesthesia professionals may actively participate in the same procedure.
Complex surgery, major trauma, or other demanding cases may require additional anesthesia support. If both professionals provided medically necessary services, separate claims may be legitimate.
What matters is whether the medical record and claims support what each professional actually did.
What If My Surgeon Was In Network but the Anesthesiologist Was Out of Network?
This must be infuriating for patients.
You can try to select your in-network surgeon and hospital, but you have little to no say over who is assigned as the anesthesiologist.
Luckily, there is the No Surprises Act starting January 1, 2022.
Most employer-sponsored health plans, Marketplace health plans, and individual health plans will prohibit an out-of-network anesthesiologist from balance billing you for out-of-network anesthesia services at an in-network hospital or ambulatory surgery center. Your out-of-pocket costs can’t be higher than they would be with an in-network provider.
Anesthesia services are considered ancillary care under this act, and the anesthesia services are provided in a non-emergency setting. It is the patient’s right to not waive the No Surprises Act.
So before you pay any out-of-pocket cost for this bill, you should look into it further.
Surprise Anesthesia Bills in Texas
Texas patients may have protections under both state and federal law.
Texas law protects consumers with many TDI-regulated health plans from balance billing for emergency care and services received at an in-network facility when the patient did not have a meaningful choice of provider. The Texas Department of Insurance specifically uses an assigned anesthesiologist as an example of this situation.
Look at your insurance card. Many Texas-regulated plans include TDI or DOI identification.
When Texas protections apply, disputes over payment between the out-of-network provider and insurer are generally handled through the state’s dispute-resolution process rather than by billing the patient for the disputed balance.
Surprise Anesthesia Bills in Virginia
Virginia also has state balance-billing protections.
Virginia law covers certain emergency services and non-emergency professional services received during scheduled care at an in-network facility. The Virginia State Corporation Commission specifically lists anesthesia among the protected professional services.
When the law applies, the patient generally remains responsible only for the cost sharing that would have applied to an in-network service, such as the deductible, copayment, or coinsurance. The payment disagreement is handled between the insurer and out-of-network provider.
Virginia’s state rules apply to specified Virginia-regulated plans. Federal protections may apply when the state law does not.
How Do I Read and Verify an Anesthesia Bill?
Do not judge the bills only by the total amount. Compare the actual claim details.
Start with:
Provider name. Is one claim from an anesthesiologist and another from a CRNA?
Date of service. Do both claims relate to your actual surgery date?
CPT code. Anesthesia procedure codes commonly fall within the CPT 00100–01999 range.
Modifiers. Anesthesia claims may contain modifiers identifying whether the anesthesiologist personally performed the service, medically directed another anesthesia professional, or whether a CRNA provided the service.
Anesthesia time. Unlike many physician services, anesthesia payment is heavily influenced by time.
Allowed amount. This is the amount your health plan recognizes under its coverage and contract rules. It can be much lower than the provider’s original charge.
Insurance payment and patient responsibility. Compare these figures against your Explanation of Benefits, or EOB.
How base units and time units affect anesthesia charges
Anesthesia billing does not usually work like a simple flat fee.
Under Medicare’s methodology, anesthesia payment is calculated using base units plus time units, multiplied by a locality-specific anesthesia conversion factor. Medicare generally treats 15 minutes of anesthesia time as one time unit.
Base units reflect characteristics of the anesthesia procedure, while time represents how long the anesthesia professional provided qualifying anesthesia care.
Commercial insurers may use different contractual formulas, so do not assume that a Medicare calculation will match a commercial plan.
If the bill is unclear, request an itemized statement showing the anesthesia code, provider, billed amount, and relevant service details.
Make Sure One Document Isn’t Just an EOB
An Explanation of Benefits is not a bill.
Your insurer sends an EOB to explain:
- what the provider charged;
- what the plan allowed;
- what insurance paid;
- what amount was denied or adjusted;
- what the insurer says you may owe.
CMS recommends paying only after receiving the provider’s actual bill and comparing it with the EOB to confirm that the amounts match.
Patients sometimes believe they have received two bills when one document is actually the insurer’s EOB.
How to Tell if Two Anesthesia Bills Are Duplicates
Compare both statements side by side.
A possible duplicate deserves investigation when both bills show the same:
- provider;
- date of service;
- anesthesia CPT code;
- service description;
- anesthesia time;
- charge;
- claim details.
Different provider names or anesthesia-team roles may explain why two separate claims exist.
Do not assume either way. Ask for clarification.
How to Dispute an Incorrect or Excessive Anesthesia Bill
If something does not look right:
- Compare both bills with your EOB. Make sure the patient-responsibility amounts match what your insurer processed.
- Request an itemized bill. Ask for the CPT code, provider information, date of service, and other claim details.
- Call the anesthesia billing office if the concern involves duplicate services, incorrect dates, provider identity, anesthesia time, or unexplained charges.
- Call your insurer if the concern involves a denial, allowed amount, network status, deductible, coinsurance, or incorrect out-of-network processing.
- Mention the No Surprises Act if an out-of-network anesthesiologist billed you after covered care at an in-network facility.
- Use your state regulator when appropriate. Texas patients can contact the Texas Department of Insurance; Virginia patients can contact the Virginia State Corporation Commission.
- Escalate federal surprise-billing problems through the No Surprises Help Desk at 1-800-985-3059. CMS accepts questions and complaints regarding possible violations.
If you were uninsured or chose not to use insurance, another rule may apply. Patients who received a good faith estimate and are later billed at least $400 more than that estimate may qualify for the federal patient-provider dispute-resolution process, subject to eligibility and filing requirements.
When Should You Call the Insurer vs. the Billing Office?
Call the anesthesia billing office first when the issue involves what was actually billed:
- duplicate services;
- wrong date;
- incorrect provider;
- questionable anesthesia time;
- charges you do not recognize;
- missing itemization.
Call your insurance company when the problem involves:
- a claim denial;
- out-of-network processing;
- an incorrect deductible;
- coinsurance;
- allowed amounts;
- benefits;
- No Surprises Act processing.
Often, the quickest resolution requires speaking with both.
Clearer Anesthesia Billing Starts Before the Claim Is Sent
For providers, confusing patient statements may indicate problems with their entire revenue cycles, including incorrect modifiers, duplicate submissions, issues with anesthesia time, questions of patient eligibility, and a lack of communication between the facility and anesthesia group.
Resilient MBS helps medical facilities in Texas, Virginia, and throughout the U.S. with solving and preventing a variety of problems in and out of the revenue cycle including, but not limited to medical coding reviews, claims submissions, managing denials, receivables postings, and AR follow-up. Cleaner claims help patient statements and medical bills become more comprehensible.
Frequently Asked Questions
1. Are two anesthesia bills a scam?
Not necessarily. Separate bills may represent an anesthesiologist and CRNA, separate anesthesia-provider roles, or an anesthesia practice that bills independently from the hospital. Compare the provider names, service date, claim details, and EOB before assuming fraud.
2. Why did the anesthesiologist bill me separately from the hospital?
Anesthesia professionals often belong to an independent anesthesia group rather than the hospital or surgery center. Their professional services can therefore generate a separate claim.
3. Why do I have a CRNA bill and an anesthesiologist bill?
Both professionals may have participated in your anesthesia care. Depending on the care-team arrangement and payer requirements, their services may appear on separate claims.
4. Can an out-of-network anesthesiologist bill me if my hospital was in network?
Federal No Surprises Act protections generally prohibit balance billing for covered out-of-network anesthesia services provided as ancillary care at an in-network hospital or ambulatory surgical center for health plans subject to the law.
5. Can I refuse to pay a second anesthesia bill?
Do not simply ignore it. First verify whether the bill is legitimate, compare it with your EOB, and dispute any duplicate or incorrectly processed charge. Ask the billing office whether the account can be placed on hold while the issue is reviewed.
6. What should I do if insurance denied my anesthesia claim?
Call the insurer and ask for the exact denial reason. Then contact the anesthesia billing office if corrected coding, documentation, authorization information, or a claim appeal may be needed.
7. What is balance billing?
Balance billing occurs when an out-of-network provider seeks payment from the patient for the difference between the provider’s charge and the amount recognized or paid by the health plan. Federal and state laws prohibit this practice in certain situations.
8. How can I tell if two anesthesia charges are duplicates?
Compare the provider, date, CPT code, anesthesia time, billed amount, claim number, and service description. If those details are identical and the billing office cannot explain the difference, request a formal review.
9. Do Texas and Virginia protect patients from surprise anesthesia bills?
Yes, both states have balance-billing protections for qualifying health plans and situations, and federal No Surprises Act protections may also apply. Texas patients should check whether their plan is TDI-regulated, while Virginia patients should verify whether their coverage falls under Virginia’s state rules or federal protections.
10. Who should I call first about a confusing anesthesia bill?
Call the anesthesia billing office first if you do not recognize the provider or service. Call your insurer first when the problem clearly involves network status, denial, allowed amount, deductible, or coinsurance. For possible federal surprise-billing violations, the No Surprises Help Desk is available at 1-800-985-3059.
