Balance Billing

Your Rights & Protections Against Surprise Medical Bills

Published in accordance with Section 2799B-3 of the Public Health Service Act (PHS Act). Federal law protects you from unexpected medical bills in certain emergency and out-of-network situations.

🛡️ You're Protected by Federal Law

If you receive emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you generally cannot be charged more than your plan's in-network cost-sharing amount.

💳 What Is Balance Billing?

Balance billing happens when an out-of-network provider bills you for the difference between what your insurance pays and the provider's full charge.

Also called "Surprise Billing"

This often occurs during emergencies or when you unknowingly receive care from an out-of-network provider while visiting an in-network facility.

🚑 Emergency Services

If you experience a medical emergency and receive emergency services from an out-of-network provider or facility, you cannot be balance billed.

  • You only pay your normal in-network deductible, copay, or coinsurance.
  • Your protections continue after stabilization unless you voluntarily waive them in writing.

🏥 In-Network Hospitals

Even when visiting an in-network hospital or ambulatory surgical center, some specialists may not participate with your insurance network.

  • Emergency Medicine
  • Anesthesia
  • Pathology
  • Radiology
  • Laboratory Services
  • Neonatology
  • Hospitalists
  • Assistant Surgeons
  • Intensivists
These providers generally cannot balance bill you for covered services.

✅ Your Rights

  • You are never required to receive out-of-network care.
  • You may always choose an in-network provider.
  • You are responsible only for your normal in-network cost sharing.
  • Your insurance company must pay any additional covered amount directly to the provider.
  • Emergency costs count toward your in-network deductible and annual out-of-pocket maximum.
  • Most emergency services cannot require prior authorization.

Need Help?

If you believe you've been improperly balance billed, you can contact the No Surprises Help Desk.

📞 1-800-985-3059

For additional information about your rights under federal law, visit:

www.cms.gov/nosurprises/consumers

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