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No Surprise Billing

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.

 

Under the law, health care providers need to give patients who do not have insurance or are not using insurance an estimate of the bill for medical items and services.

 

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescriptions drugs, equipment and hospital or surgery center fees.

     

  • Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical services or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

     

  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

     

  • Make sure to save a copy or picture of your Good Faith Estimate.

 

For questions or for more information about your right to a Good Faith Estimate visit www.cms.gov/nosurprises or call 1/800-985-3059.

Your Rights and Protections Against Surprise Medical Bills

 

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.

 

What is 'balance billing' (surprise billing)?

 

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a co-payment, deductible and/or a coinsurance. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that is not in your health plan's network.

 

'Out-of-network' describes providers and/or facilities that have not 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 'balance billing'. This amount is likely more than in-network costs for the same service and might not count towards your annual deductible and out-of-pocket limits.

 

'Surprise billing' is a unexpected balance bill. This can happen when you can not control who is involved in your care. For example; you have an emergency and go to 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 emergent medical condition and have emergency services from an

out-of-network provider or facility, the most the provider or facility may bill you

is your plan's in-network cost-sharing amount. You cannot be balance billed for

these emergency services. This includes services you may have after you are

in stable condition, unless you give written consent and give up your protections

not to be balanced billed for these post-stabilization services.

 

In-network hospital or ambulatory surgical center: When having services done in this setting, certain providers may be

out-of-network. In these cases, the most those providers may bill you is your

plan's in-network cost-sharing amounts. This applies to emergency

medicine, anesthesia, pathology, radiology, laboratory, assistant surgeon,

hospitalist or intesivist services. These providers cannot balance bill you

and may not ask you to give up your protections.

 

You are not required to have out-of-network care and you can choose a provider or facility that is in your plan's network.

 

Your Protections:

 

  • You are responsible for paying your share of costs. These include, co-payments, deductibles and/or coinsurance that you would pay if the provider or facility was in-network. Your health plan should pay out-of-network providers and facilities directly.

 

Your Health Plan:

 

  • Cover emergency services without prior authorization.

     

  • Cover emergency services by out-of-network providers.

     

  • Show your in-network cost-sharing amounts on your explanation of benefits of your responsibility to a provider or facility.

     

  • Apply any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket accumulations.

     

     

If you believe you have been wrongly billed, please contact the facility or providers administration.

 

 

You may visit https://www.cms.gov/nosurprises for more information and about your rights under federal law.

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