No Surprises Act Disclosure
When you are treated by an out-of-network provider at an in-network facility you are protected from surprise balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible.
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 must 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 schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.
You’re protected from balance billing for:
Certain services at an in-network facility
When you get services from an in-network facility, 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. 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 protection.
You’re never required to give up your protection 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.
California Law: California law generally contains balance billing protections like those under the No Surprises Act (as described in this Notice), except that the balance billing prohibitions also apply to services received in additional in-network facilities. California also has an independent dispute resolution process to resolve claims-related issues, including disputes with your provider pertaining to receipt of improper balance bills, which can be initiated through the California Department of Insurance.
If you have a concern about how much you were billed on the service at our facility, please contact us at 800.698.1280 for assistance. You may also choose to contact the HHS No Surprises Helpdesk at 1- 800-985-3059, the entity responsible for enforcing the federal balance or surprise billing protection laws. Visit www.cms.gov/nosurprises/consumers for more information about your rights under federal law.
For more information about your rights under California law, including how to initiate the dispute resolution process, contact the Department of Insurance Help Center online at http://www.insurance.ca.gov/01- consumers/101-help/index.cfm, or call 1-800-927-4357, the entity responsible for enforcing state balance or surprise billing protection laws.
