Recently, my household received a short, first-of-its-kind (for us) notice from a health care provider — an imaging center. The notice said that, for an upcoming appointment, there could be two bills.

One bill would come from the imaging center itself as a “facilities fee.” This would cover nurses, supplies, equipmen, and other costs associated with running the imaging center’s business. The second bill would come from one or more doctors who performed the actual scheduled procedure but were not employees of the imaging center. The notice we received suggested that health insurance might not cover some or all of these bills and we should check this out with our insurance plan.

This notice caused me to ask, in a lawyerly sort of way: Why was it sent? Was the notice legally required or was it merely an act of good customer service by the imaging center? Since good customer service is hard to come by these days in health care, I suspected legal necessity.

Going down that path, there is both a federal and Colorado law aimed at limiting surprises from medical bills. Both laws deal with situations where a patient ends up being treated by an “out-of-network” doctor the patient did not knowingly choose. This can happen at an emergency room or at a hospital in connection with a surgery. (“In-network” means there is a contract in place between a health insurance company and the medical services provider governing how much and when the medical services provider will be paid.)

Both the federal and state laws, in at least some circumstances, limit a patient’s liability for out-of-network charges to what the patient would have been charged if the services had been provided in network. This is definitely the case if you are treated at an emergency room following an injury. (Thus, the next time you’re hurt in a car accident, there will be no need to comparison shop for emergency room services.)

Because disputes between out-of-network providers and health insurance plans are predictable, both the federal and Colorado laws include a dispute resolution process whereby the out-of-network provider, wanting to be paid more, and the patient’s health insurance company, wanting to pay less, can duke it out while leaving the patient out of the middle.

Since both the state and federal laws require disclosures to patients of various kinds, I finally decided, without fully understanding the details, that the you-might-get-two-bills notice we received must have been the result of the imaging center’s attempt at complying with one or both of these laws.

By way of brief legislative history, the Colorado no-surprises billing act goes back to 2019 (House Bill 19-1174) and became effective Jan. 1, 2020. The federal law came later and was tucked away deep inside the massive (2,123 pages) 2021 Consolidated Appropriations Act. It became effective Jan. 1, 2022.

The Colorado Division of Insurance website provides basic information about out-of-network billing. Another resource is the Colorado Consumer Health Initiative. This is a non-profit organization whose staff members have spent much time in the trenches of health care and are knowledgeable about the Colorado and federal no-surprises laws.

So what happened to the notice we received from the imaging center? Well, we threw it away. Two bills for one procedure, we decided, was something for our health plan to sort out.

Jim Flynn is a business columnist. He is of counsel with the Colorado Springs firm Flynn & Wright LLC. He can be contacted at moneylaw@jtflynn.com.