Advertising an out-of-network practice: insurance wording, superbills and estimates

Plenty of independent practices are not in network with any health plan, or with only one or two. Their patients still have insurance, so the website, the ads and the front desk end up answering the same question again and again: will my plan help pay? The answers practices write, such as “we work with your insurance”, “we provide superbills” or “we will submit to your plan for you”, sound helpful. Each one is a claim about network status and about money, and each one can mislead a patient if the words promise more than the plan will do.

This guide covers the three insurance positions patients mix up, the federal rules that apply to how an out-of-network practice describes itself, when a patient with insurance counts as self-pay for good faith estimates, the No Surprises Act notice and consent process for practices that treat patients at in-network facilities, waived deductibles and copays, two state laws written for this situation, and Google Ads policy. How to keep a list of the plans you are in network with accurate, and the plan directory rules, are in our insurance accepted page guide. The estimate rules for uninsured and self-pay patients are in our good faith estimate guide, and practices that have opted out of Medicare should read our guide to Medicare opt-out practice advertising, since Medicare works differently. Practices that see veterans through VA community care should read VA community care provider marketing.

The short version

• Say your network status in plain words. “We are not in network with any health plan” or a list of the plans you are in network with. Avoid “we accept” or “we work with” a plan you have no contract with.
• A superbill is a receipt, not a promise. Say the plan decides whether it pays and how much, and that out-of-network benefits differ from plan to plan.
• An insured patient who will not have a claim submitted counts as self-pay. The good faith estimate rules apply to them, so ask the question at booking.
• Treating at an in-network hospital or surgery center brings in the No Surprises Act. Balance billing there needs a separate notice and signed consent on the HHS form, and for certain services it is not allowed at all.
• Do not advertise waived deductibles or copays. For Medicare and Medicaid patients, the federal exception for waivers does not cover waivers offered in an advertisement.
• State law can add duties. New York requires out-of-network professionals to tell patients a bill amount is available on request. Connecticut limits what counts as a request for payment.

Three positions patients mix up

From a patient’s point of view, a practice can be in one of three positions with their plan, and the website has to make clear which one applies.

• In network. The practice has a contract with the plan. The patient pays in-network cost sharing, and the practice bills the plan.
• Out of network, the practice files the claim. There is no contract. The practice sends the claim to the plan as a courtesy, and the plan pays under its out-of-network benefits, if it has any. The patient may owe the difference between the practice’s charge and what the plan pays.
• Out of network, the patient files the claim. The patient pays the practice in full and receives an itemized statement, known as a superbill, with the codes and details a plan needs. The patient sends it to the plan, and the plan decides whether to reimburse them and how much.

The phrases “we accept your insurance”, “we take all plans” and “we work with your insurance” blur these lines. A patient can read any of them as the first position. If the practice is in the second or third, the patient finds out from a bill.

What federal law asks of the wording

Section 5 of the FTC Act, 15 U.S.C. 45(a)(1), declares unfair or deceptive acts or practices in or affecting commerce unlawful. The FTC Policy Statement on Deception explains that the agency looks for a representation, omission or practice that is likely to mislead a consumer acting reasonably in the circumstances, and that is material, meaning likely to affect the consumer’s conduct or decision. It looks at the net impression of the whole message, not single phrases, and says express claims are presumed material and that information about the cost of a product or service has been found material.

Applied to insurance wording, two things follow. First, what a patient takes away from the page as a whole counts. A large “Insurance welcome” banner with “out of network” in small print further down can leave the wrong impression. Second, leaving something out can mislead. A page that says “we provide superbills for reimbursement” without saying the plan may pay nothing omits a fact that matters to the patient’s decision to book.

There is no federal definition of a superbill, so the safe ground is to describe what you give the patient and what you do not control. You control the statement and its accuracy. The plan controls whether the patient has out-of-network benefits, whether a deductible applies first, what amount the plan treats as allowed, and how fast it pays.

Self-pay patients with insurance and the good faith estimate

Under 45 CFR 149.610(a)(2), an uninsured (or self-pay) individual includes a person who has benefits for an item or service under a group health plan or individual or group health insurance coverage but who does not seek to have a claim for it submitted to that plan or coverage. For those patients, the good faith estimate rules apply in the same way as for patients with no coverage.

Section 149.610(b)(1) requires the convening provider to find out which patients these are. The practice must ask whether the person is enrolled in a plan or coverage and, if so, whether they are seeking to have a claim submitted for the primary item or service. It must then tell all uninsured and self-pay patients that a good faith estimate is available, both on scheduling and on request. That information must be written in a clear and understandable manner and prominently displayed, and easily searchable from a public search engine, on the provider’s website, in the office and where scheduling or cost questions happen. It must also be given orally when scheduling or when cost questions come up. Under 149.610(b)(1)(iv), any discussion or inquiry about the potential cost of items or services counts as a request for a good faith estimate.

The regulation does not say how to treat a patient who plans to send a superbill to their plan themselves, so ask the question in the words of the rule: “Are you seeking to have a claim submitted to your plan for this visit?” Record the answer, and where it is unclear, giving the estimate costs little. The CMS page on good faith estimates explains the patient side, including that a patient needs the estimate if they want to dispute their bill. The full timeline is in our good faith estimate guide.

When you treat at an in-network facility: notice and consent

The No Surprises Act rules on balance billing for non-emergency care do not reach a visit to a stand-alone office. 45 CFR 149.420 applies when a nonparticipating provider furnishes non-emergency items or services to a plan member at a participating health care facility. For non-emergency services, the regulations define these facilities as hospitals, hospital outpatient departments, critical access hospitals and ambulatory surgical centers. Our No Surprises Act website disclosure guide covers the separate homepage notice that certain of these providers must post.

In that setting, under 149.420(a), the out-of-network provider must not bill the patient more than in-network cost sharing unless it meets the notice and consent criteria in 149.420(c). Those criteria cannot be met through advertising or a line on a website. They require:

• A written notice, on paper or electronically as the patient chooses, in the form HHS sets in guidance, given with the consent document and physically separate from other documents.
• Timing: no later than 72 hours before the service when the appointment is made at least 72 hours ahead, or on the day the appointment is made when it is made within 72 hours. When the notice is given on the day of the service, it must be at least 3 hours before.
• Content under 149.420(d): that the provider is out of network with the plan, a good faith estimate of what the provider may charge, a statement that prior authorization or other care management limits may apply, and a clear statement that consent is optional and the patient may instead choose an available in-network provider.
• A consent under 149.420(e), signed on the HHS form before the service, that records the date and time of the notice and the signature, and acknowledges that the payment might not count toward the in-network deductible or out-of-pocket maximum.
• The choice of the notice and consent in any of the 15 languages spoken by the largest numbers of people in the state or region, or a qualified interpreter, under 149.420(f).
• Keeping the signed notice and consent for at least 7 years under 149.420(h), and notifying the plan under 149.420(i).

Under 149.420(b), the notice and consent route is not available at all for ancillary services: emergency medicine, anesthesiology, pathology, radiology and neonatology, assistant surgeons, hospitalists and intensivists, diagnostic services including radiology and laboratory, and services where no in-network provider at the facility can furnish them. It is also not available for items or services that result from unforeseen, urgent medical needs at the time of the service. A surgeon’s page that says “we are out of network, so you may be balance billed for your procedure at [Hospital]” is therefore incomplete at best, and misleading for a patient whose services fall in those groups.

Waived deductibles and copays

“We accept your insurance as payment in full” and “we waive your out-of-network deductible” are attractive lines for an out-of-network practice. They raise legal questions that differ by payer.

For people with Medicare or a state health care program, 42 U.S.C. 1320a-7a(a)(5) provides civil money penalties for offering or transferring remuneration that the person knows or should know is likely to influence the patient to order or receive items or services from a particular provider when the program may pay. Under 1320a-7a(i)(6)(A), a waiver of coinsurance and deductible amounts falls outside the definition of remuneration only if the waiver is not offered as part of any advertisement or solicitation, the person does not routinely waive these amounts, and the person waives them after a good faith finding of financial need or fails to collect after reasonable collection efforts. An advertised waiver does not meet the first condition. Medicare also has its own enrollment options in place of out of network, which our Medicare opt-out guide explains.

For private plans, the plan contract and state law decide. Check both, and have an attorney review any waiver policy before it appears in marketing.

State laws: two examples

New York Public Health Law section 24 is written for this situation. Section 24(1) requires a health care professional, or a group practice on their behalf, to disclose to patients or prospective patients, in writing or through an internet website, the health care plans in which the professional is a participating provider and the hospitals with which the professional is affiliated, before non-emergency services, and verbally at the time an appointment is scheduled. Under section 24(2), if the professional does not participate in the network of the patient’s plan, the professional must tell the patient before non-emergency services that the amount or estimated amount they will be billed is available on request, and on request must give that amount in writing.

Connecticut General Statutes section 20-7f makes it an unfair trade practice for a health care provider to request payment from an enrollee, other than cost sharing, for services covered under a health care plan, for covered emergency services rendered by an out-of-network provider, or for a surprise bill as defined in Connecticut insurance law. The statute counts as a request for payment an invoice or other communication detailing the cost of services that is not clearly marked with the phrase “This is not a bill”. A court decision noted in the official annotations read the balance billing ban in subsection (b) as applying to providers in a contract with the patient’s plan, not to out-of-network providers. If you see Connecticut patients, ask an attorney how the section applies to your estimates and statements.

These are two states, not a survey. Other states have their own network disclosure and balance billing laws, so check yours with your state health or insurance department.

Google Ads and the landing page

Google Ads applies its Misrepresentation policy to insurance claims in ads and on landing pages. Under misleading representation, the policy says that making misleading statements, obscuring, or omitting material information about your identity, affiliations, or qualifications is not allowed. Its list of unacceptable business practices includes making it seem like you are supported by another brand, organization or government entity when you are not. An ad that names an insurer, or a landing page that shows insurer logos, can suggest a network relationship the practice does not have.

The Unavailable offers part of the same policy says promising products, services or promotional offers in the ad that are unavailable or are not easily found from the destination is not allowed. If an ad says “superbills provided” or “we file out-of-network claims for you”, the landing page should explain that service and its limits where a patient will see it. For the rest of the health ad rules, see our guide to Google Ads and lead generation for practices.

What to say at booking

The front desk, the phone line and any automated booking assistant should give the same answer as the website. A short, accurate script:

• “We are not in network with [Plan]. You can still see us. We will give you an itemized statement, called a superbill, that you can send to your plan.”
• “Your plan decides whether it pays anything for out-of-network care and how much. You can call the number on your card and ask about out-of-network benefits for [type of visit].”
• “Are you seeking to have a claim submitted to your plan for this visit? If not, we will send you a good faith estimate of the cost.”
• “Our fee for [type of visit] is [amount], paid at the visit.”

If the assistant or staff do not know whether a plan will pay, they should say so. “I do not know what your plan will pay” is accurate. “You should get the bulk of it back” is a promise the practice cannot keep.

Questions to ask before you publish insurance wording

• Does each page say plainly whether we are in network with the patient’s plan?
• Do we name a plan anywhere we do not have a current contract with?
• Does any sentence suggest the plan will pay, or say how much patients get back?
• Does the page say who files the claim, us or the patient?
• Is the good faith estimate notice on the website, prominent and searchable?
• Do staff ask whether the patient is seeking to have a claim submitted?
• Do any of our clinicians treat patients at an in-network hospital or surgery center?
• Do we see patients in New York, Connecticut or another state with its own disclosure rules?
• Does any ad, page or script mention waiving deductibles or copays?

Use and avoid

• Use: “We are not in network with any health plan.” Avoid: “We work with your insurance.”
• Use: “We are in network with [Plan A] and [Plan B].” Avoid: “We accept all major insurance.”
• Use: “We give you a superbill you can send to your plan. Your plan decides whether it pays.” Avoid: “Get reimbursed by your insurance.”
• Use: “As a courtesy, we will send the claim to your plan. You pay any amount the plan does not cover.” Avoid: “We handle your insurance, so you do not have to.”
• Use: “Ask your plan about out-of-network benefits before your visit.” Avoid: “Patients get back [amount] percent of our fee.”
• Use: “Our fee for a new patient visit is [amount].” Avoid: “Insurance accepted as payment in full.”
• Use: plan names only in a plain-text list of current contracts. Avoid: insurer logos on the homepage or in ads.

An illustration

This example is invented. [Practice name], a chiropractic and physical therapy practice in [Town], left its last insurance network a year ago. The homepage still says “Insurance welcome” with logos of four insurers, and a Google Ads ad reads “In-network alternative: we work with your insurance”. A new patient books, pays at the visit, sends the superbill to their plan and learns their plan has no out-of-network benefits for this kind of care. They leave a complaint on the practice’s Business Profile and ask for a refund.

The owner rewrites the insurance page to say “We are not in network with any health plan”, lists the fee for each visit type, explains what a superbill is and that the plan decides whether to pay, and adds the good faith estimate notice. The logos come down, the ad is rewritten to name the visit and the fee, and the booking script now asks whether the patient is seeking to have a claim submitted. Because the practice sees patients across the state line in New York, the owner asks their attorney to check the script against Public Health Law section 24.

Checklist

• Network status is stated plainly on the homepage, insurance page and booking page.
• Plan names appear only for current contracts, with no insurer logos.
• Superbill wording says the plan decides whether and how much it pays.
• Courtesy claim filing, if offered, says the patient pays what the plan does not.
• No reimbursement amounts, percentages or speed promises appear anywhere.
• The good faith estimate notice is on the website, in the office and in the booking script.
• Staff ask whether the patient is seeking to have a claim submitted, and record the answer.
• Clinicians who treat at in-network facilities use the HHS notice and consent forms, and know the services where consent is not allowed.
• No ad, page or script offers waived deductibles or copays.
• State disclosure rules for each state you serve are checked, with New York and Connecticut on the list if they apply.
• Google Ads ads and landing pages match the insurance page.

How we help

We build practice websites, local SEO, Google Ads and lead generation and an AI front desk for independent practices. For an out-of-network practice, we write insurance and fee pages that state network status in plain words, keep ads and landing pages in step with them, place the good faith estimate notice, and set up the booking script so the AI front desk asks the self-pay question and does not guess what a plan will pay. Our tools are built with HIPAA in mind. We confirm in writing what a BAA covers before any patient information flows through a tool, and if it is not covered, we do not route patient information through it. We are not a healthcare provider and we do not give legal or medical advice. For the wider rules, see our healthcare marketing rules guide.

Sources

• 45 CFR 149.420: Balance billing in cases of non-emergency services performed by nonparticipating providers at certain participating health care facilities
• 45 CFR 149.610: Requirements for provision of good faith estimates of expected charges for uninsured (or self-pay) individuals
• 45 CFR 149.30: Definitions (health care facility)
• CMS: Good faith estimate (last modified October 5, 2026)
• 15 U.S.C. 45: Unfair methods of competition unlawful; prevention by Commission
• FTC Policy Statement on Deception (October 14, 1983)
• 42 U.S.C. 1320a-7a: Civil monetary penalties
• New York Public Health Law section 24: Disclosure
• Connecticut General Statutes section 20-7f: Unfair billing practices
• Google Ads policy: Misrepresentation

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