Your Rights and Protections Against Surprise Medical Bills 

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance and estimate of the bill for medical items and services. 

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• 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 cost like assessments, testing, and different types of therapy.

• Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical services. You can also ask your health care provider, and any other provider you choose for a Good Faith Estimate before you schedule 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.

• When you are treated by an out-of-network provider 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.

• 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.

• When balance billing isn’t allowed, you also have these protections: • 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: * 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 out-of-network services toward your in-network deductible and out-of-pocket limit. If you think you’ve been wrongly billed, contact The federal phone number for information and complaints is: 1-800-985-3059]. Visit www.cms.gov/nosurprises/consumers for more information about your rights under federal law.