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你r Rights and Protections Against Surprise Medical Bills

你r 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 平衡账单.

What is “平衡账单” (sometimes called “surprise billing”)?

When you see a doctor or other health care provider, 你可能需要支付一些自付费用, 比如共同支付, 共同保险, 和/或免赔额. 你 may have other costs or have to pay the entire bill if you see a provider 或访问 a health care facility that isn’t in your health plan’s network.

“Out-of-network” describes providers and facilities that haven’t 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. 这叫做"平衡账单.” This amount is likely more than in-network costs for the same service and might 不 count toward your annual out-of-pocket limit.

“Surprise billing” is an unexpected balance bill. This can happen when you 不能 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.

你 are protected from 平衡账单 for:

紧急服务

If you have an emergency medical condition and get 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 (such as copayments and 共同保险). 你 不能 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 不 to be balanced billed for these post-stabilization services.

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 may bill you is your plan’s in-network cost-sharing amount. 这适用于急诊医学, 麻醉, 病理, 放射学, 实验室, 新生儿学, 助理外科医生, hospitalist, 或者重症监护服务. 这些提供者 不能 平衡你和我的账单 ask you to give up your protections 不 to be balance billed.

If you get other services at these in-network facilities, out-of-network providers 不能 balance bill you, unless you give written consent and give up your protections.

你’re never required to give up your protections from 平衡账单. 你 also aren’t required to get care out-of-network. 你 can choose a provider or facility in your plan’s network.

When 平衡账单 isn’t allowed, you also have the following protections:

  • 你 are only responsible for paying your share of the cost (like the copayments, 共同保险, and deductibles that you would pay if the provider or facility was in-network). 你r health plan will pay out-of-network providers and facilities directly.
  • 您的健康计划通常必须:
    • Cover emergency services without requiring you to get approval for services in advance (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 deductible and out-of-pocket limit.

如果你认为你被冤枉了,你可以联系美国.S. Department of Health and Human 服务’ No Surprises Help Desk at 1-800-985-3059 或访问 www.cms.gov / nosurprises

If you have questions or need assistance with your bill or estimate: