Eutierria Therapy

Your Rights and Protections Against Surprise Medical Bills

 

When you receive medical care, you shouldn’t have to worry about unexpected costs, especially if you didn’t choose the provider or facility. This page explains your rights and protections under the No Surprises Act, which helps protect you from surprise medical bills.

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What Is Balance Billing (Sometimes Called Surprise Billing)?

When you see a doctor or other healthcare provider, you might have out-of-pocket costs, like a copayment, coinsurance, or deductible. If you see a provider or visit a facility that’s not part of your health plan’s network (this is called “out-of-network”), you might be billed for the difference between what your plan pays and what the provider charges. This is called “balance billing.”

Surprise billing happens when you get an unexpected balance bill, like when you’re treated by an out-of-network provider at an in-network facility without knowing it.

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You Are Protected From Balance Billing For:

Emergency Services

• If you have an emergency and receive care from an out-of-network provider or facility, the most you’ll be billed is what you would pay if the provider was in-network (like copayments and coinsurance). You can’t be billed more than this amount for emergency services, even if you receive additional care after you’re stabilized, unless you give written permission to be billed more.

 

Certain Services at In-Network Hospitals or Surgical Centers

• If you get care at an in-network hospital or ambulatory surgical center, some of the providers there might be out-of-network. Even in these cases, they can only bill you the same amount you’d pay if they were in-network. This includes services like emergency medicine, anesthesia, pathology, radiology, and more. You are protected from extra charges unless you give written consent to be billed more.

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Your Protections When Balance Billing Isn’t Allowed

When balance billing isn’t allowed, you’re protected in the following ways:

• You’re only responsible for paying your share of the cost, such as copayments, coinsurance, and deductibles, as if the provider was in-network.

• Your health plan will pay out-of-network providers and facilities directly.

• Your health plan must:

  • Cover emergency services without needing you to get pre-approval (prior authorization).

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

  • Base what you owe on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.

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

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What to Do If You Think You’ve Been Wrongly Billed

If you believe you’ve been wrongly billed or want more information about your rights under Federal law, you can visit www.cms.gov/nosurprises or call the No Surprises Help Desk at 1-800-985-3059. The help desk is available from 8 am to 8 pm EST, seven days a week.