When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.<\/p>\n\n\n
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance and\/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn\u2019t in your health plan\u2019s network.<\/p>\n\n\n\n
\u201cOut-of-network\u201d describes providers and facilities that haven\u2019t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called \u201cbalance billing<\/strong>.\u201d This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.<\/p>\n\n\n\n \u201cSurprise billing\u201d is an unexpected balance bill. This can happen when you can\u2019t control who is involved in your care\u2014like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.<\/p>\n\n\n If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan\u2019s in-network cost-sharing amount (such as copayments and coinsurance). You can\u2019t <\/strong>be balance billed for these emergency services.This includes services you may get after you\u2019re in stable condition unless you give written consent and give up your protections not to be balance billed for these post-stabilization services.<\/p>\n\n\n When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan\u2019s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist or intensivist services. These providers can\u2019t <\/strong>balance bill you and may not<\/strong> ask you to give up your protections not to be balance billed.<\/p>\n\n\n\n If you get other services at these in-network facilities, out-of-network providers can\u2019t<\/strong> balance bill you unless you give written consent and give up your protections.<\/p>\n\n\n\n You\u2019re<\/strong> never<\/u> required to give up<\/strong> your protections from <\/strong>balance billing. You also aren\u2019t<\/strong> required to get care out-of-network.<\/strong> You can choose a <\/strong>provider or <\/strong>facility in your plan\u2019s network.<\/strong><\/p>\n\n\n You are only responsible for paying your share of the cost (like the copayments, coinsurance and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.<\/p>\n\n\n\n Your health plan generally must:<\/strong><\/p>\n\n\n\n Cover emergency services without requiring you to get approval for services in advance (prior authorization).<\/p>\n\n\n\n Cover emergency services by out-of-network providers.<\/p>\n\n\n\n Base what you owe the provider or facility (cost-sharing) on what it would pay an in\u2011network provider or facility and show that amount in your explanation of benefits.<\/p>\n\n\n\n Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.<\/p>\n\n\n\n If you believe you\u2019ve been wrongly billed<\/strong>, you may contact the following:<\/p>\n\n\n\n Federal: Call the No Surprises Help Desk at 1 (800) 985-3059<\/a>, file a complaint online at www.cms.gov\/nosurprises\/consumers\/complaints-about-medical-billing<\/a> or start a dispute online at www.cms.gov\/nosurprises\/consumers\/medical-bill-disagreements-if-you-are-uninsured<\/a>.<\/p>\n\n\n\nYou are protected from balance billing for:<\/h3>\n\n
Emergency services<\/h4>\n\n\n
Certain services at an in-network hospital or ambulatory surgical center<\/h4>\n\n\n
When balance billing isn\u2019t allowed, you also have the following protections:<\/h3>\n\n\n