Surprise Billing Protections

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 balance billing. In these cases, you shouldn't be charged more than your plan's copayments, coinsurance and/or deductible.

What is "balance billing" (sometimes called "surprise billing")?

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a health care facility that isn't in your health plan's network.

"Out-of-network" means providers and facilities that haven't signed a contract with your health plan to provide services. Out-of-network providers may be allowed to 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 plan's deductible or 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. Surprise medical bills could cost thousands of dollars depending on the procedure or service.

Emergency services

If you have an emergency medical condition and get emergency services from an out-of- network provider or facility, the most they can bill you is your plan's in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). 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 not to be balanced billed for these post-stabilization services.

Applicable State balance billing information may be found at the bottom of this notice.

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 can 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 not to be balance billed.

If you get other types of services at these in-network facilities, out-of-network providers can't balance bill you, unless you give written consent and give up your protections.

You're never required to give up your protections from balance billing. You also aren't required to get out-of-network care. You can choose a provider or facility in your plan's network.

Applicable State balance billing information may be found at the bottom of this notice.

• You're only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.
• Generally, your health plan must:
  • Cover emergency services without requiring you to get approval for services in advance (also known as "prior authorization").
  • Cover emergency services by out-of-network providers.
  • Base what you owe the provider or facility (cost-sharing) 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 services or out-of-network services toward your in-network deductible and out-of-pocket limit.

If you think you've been wrongly billed, contact
Centers for Medicare & Medicare Services (CMS)
Website: https://www.cms.gov/nosurprises/consumers
Phone: 1-800-985-3059

Visit Centers for Medicare & Medicaid Services No Surprises Act for more information about your rights under federal law

Under the law, health care providers need to give patients who don't have insurance or who 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, prescription drugs, equipment, and hospital fees.
• Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service 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 more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.

Patients get surprise medical bills if they get care outside their health plan’s network without realizing it. For example, a patient may pick a surgeon in her plan’s network, however; the patient may not be asked about the anesthesiologist. Texas state law may protect patients with state-regulated health insurance from surprise medical bills in emergencies and when they didn’t have a choice of doctors. A patient has a right to be provided: a written disclosure that confirms whether the facility is in-network based on the insurance information the patient provides; to be told that facility-based physicians may bill separately and may not participate in the patient’s insurance plan; to request a list of physicians that have been granted medical staff privileges at that facility and to request from that facility-based physician information whether the physician is in-network with the patient’s insurance plan.

For additional information, please visit the Texas Department of Insurance website or call (800) 578-4677.

Nevada state law limits the amount a provider of healthcare may charge a person who has health insurance for certain medically necessary emergency services provided where the provider is out-of-network; requiring an insurer to arrange for the transfer of a person who has health insurance to an in-network facility under certain circumstances; prescribing procedures for determining the amount that an insurer is required to pay a provider of health care which is out-of-network for certain medically necessary emergency services provided to an insured; requiring the reporting of certain information related to that process; and providing other matters properly relating thereto.

For information on Nevada balance billing protections, please visit Nevada Division of Insurance Department of Business and Industry website or by calling (888) 872-3234.

Physicians and other healthcare providers, such as anesthesiologists, radiologists, emergency room physicians, and pathologists may not be employed by this facility. Services provided by these specialists, among others, will be billed separately. Before receiving services, the patient should check with his or her insurance carrier to find out if the patient's providers participate in the patient’s insurance network. Otherwise, the patient may be at risk of higher out-of-network charges.

Additional information is available on the Tennessee Department of Commerce and Insurance website, by calling (615) 741-2241 or by email.

Colorado state law protects Colorado consumers with state-regulated health insurance plans from being balance billed for unknowingly receiving care outside of their insurance network. If you receive a surprise bill and have questions, contact the Colorado Department of Regulatory Agencies Division of Insurance for assistance.
You may reach the Department of Regulatory Agencies (DORA) by phone at (800) 930-3745 or by email.

Virginia state law may protect you from “balance billing” when you receive:

• EMERGENCY SERVICES from an out-of-network hospital, or an out-of-network doctor or other medical provider at a hospital; or
• NON-EMERGENCY SURGICAL OR ANCILLARY SERVICES from an out-of-network lab or healthcare professional at an in-network hospital, ambulatory surgical center or other healthcare facility.

If you are billed an amount more than your payment responsibility shown on your EOB, or you believe you’ve been wrongly billed, you can file a complaint with the State Corporation Commission’s (SCC) Bureau of Insurance. To contact the SCC for questions about this notice visit the State Corporation Commission website or call (877) 310-6560.

Missouri state law prohibits out-of-network physicians from billing enrollees for any amount beyond the in-network level of cost sharing for emergency services provided by out-of-network professionals at in-network facilities provided by all or most classes of healthcare professionals. Protections do not apply to: ground ambulance services, services provided at out-of-network facilities, non-emergency services, and enrollees of self-funded plans.

The state provides a dispute resolution/appeal process. If you believe your health insurance plan denied a claim or failed to pay the correct amount, you can appeal the decision through your insurance plan or you can contact the Missouri Department of Insurance at (800) 726-7390.