Your Rights and Protections Against Surprise Medical Bills

When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, 您不会受到余额结算的保护. 在这些情况下, you shouldn't be charged more than your plan's copayments, 共同保险和/或免赔额.

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

当你去看医生或其他医疗保健提供者时, 你可能欠 一定的自付费用, 像一个 共同付费, 共同保险, 或 扣除. 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. 这被称为“余额结算”." 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.

“意外账单”是指意外的余额账单. 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.

您可以免受余额账单的保护:

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 they can bill you is your plan's in-network cost-sharing amount (such as copayments, 共同保险, 和免赔额). 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, 某些提供商可能不在网络中. 在这些情况下, the most those providers can 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. 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, 网络外供应商 不能 平衡你的账单, unless you give written consent and give up your protections.

你 从来没有 required to give up your protections from balance billing. 你也不需要获得网络外的医疗服务. 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. 

When balance billing isn't allowed, you also have these protections:

  • 你 only responsible for paying your share of the cost (like the copayments, 共同保险, 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.
  • 一般来说,您的健康计划必须:
  • Cover emergency services without requiring you to get approval for services in advance (also known as "prior authorization").
  • 覆盖网络外供应商提供的紧急服务.
  • 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.

如果你觉得你被冤枉了, 联系
医疗保险中心 & 医疗保险服务(CMS)
网站: http://www.cms.gov/nosurprises /消费者
电话: 1-800-985-3059

访问 医疗保险中心 & 医疗补助服务不意外法案 for more information about your rights under federal law

You have the right to receive a "Good Faith Estimate" explaining how much your medical care will cost

根据法律,医疗服务提供者需要给予 patients who don't have insurance or who are not using insurance 医疗项目和服务费用的估计.

  • 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. 你也可以询问你的医疗保健提供者, 以及您选择的任何其他提供商, 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, 你可以对账单提出异议.
  • 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 或打电话 1-800-985-3059.

乔治亚州惊喜账单

Georgia law defines what certain health plans must pay non-participating physicians and facilities for emergency medical services and certain nonemergency medical services rendered by a nonparticipating provider to covered persons. Patients provided emergency medical services may only be billed the co-pay or deductible or 共同保险 required under their plan. 该法还规定了解决争端的程序, mandating binding arbitration for certain payment disputes.

For information regarding 乔治亚州惊喜账单 rules, please visit 保险和安全办公室消防专员 或打电话 800-656-2298.