When you receive emergency care or treatment from an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected by law from surprise billing or balance billing.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a health care provider, you may owe out-of-pocket costs (copayments, coinsurances, deductibles). If the provider or facility is not in your plan’s network, you may have to pay more costs or the entire bill. “Out-of-network” providers may bill you for the difference between what your plan pays 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 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:
You’re never required to give up your protection from the balance billing described above. If you choose an in-network provider or facility, you will not be balance billed.
When balance billing isn’t allowed, you also have the following protections:
You are only responsible for paying your share of the cost (copayments, coinsurance, and deductibles) you would pay if the provider or facility were in-network. Your health plan will pay out-of-network providers and facilities directly. Your health plan will:
If you believe you’ve been wrongly billed, you may contact the U.S. Department of Health and Human Services (HHS) at 1-800-985-3059.
Visit www.cms.gov/nosurprises/consumers for more information about your rights under federal law.