No Surprises Act
Your Rights and Protections Against Surprise Medical Bills
When you get emergency care or are 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.
What is "balance billing" (sometimes called "surprise billing")?
When you see a doctor or other healthcare 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 healthcare facility that isn’t in your health plan’s network.
"Out-of-network" describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be allowed to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called "balance billing." This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.
"Surprise billing" is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like 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.
You are protected from balance billing for: Emergency services
If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most they may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections.
Certain services at an in-network hospital or ambulatory surgical center
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’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections.
You are never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.
When balance billing is allowed
In some cases, you may be asked to sign a notice and consent form to receive care from an out-of-network provider. If you sign, you may be responsible for out-of-network costs. However, this does not apply to emergency services or certain ancillary services listed above.
Your rights when you receive a bill
If you believe you’ve been wrongly billed, you can contact the federal No Surprises Help Desk at 1-800-985-3059. You can also visit www.cms.gov/nosurprises for more information about your rights under federal law.
State law protections
Some states have additional protections against balance billing. If your state’s law applies, you may have more protections than those described here.
Contact Us
If you have questions about your bill, your rights, or this notice, please contact us at:
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Phone: 678-841-8274