Your Rights and Protections Against Surprise Medical Bills

You are protected from surprise medical bills (also called balance billing) when you:

Receive emergency care, or
Get treated by an out-of-network provider at an in-network hospital or surgical center.

What Is Balance Billing?

Normally, you pay your in-network costs (copay, coinsurance, deductible).
If you see an out-of-network provider, they may try to bill you for the difference between what your plan pays and what they charge. This is called balance billing.
These bills are often much higher and may not count toward your deductible or out-of-pocket maximum.
A surprise bill happens when you didn’t know (or couldn’t control) that an out-of-network provider was involved in your care.

Emergency Services

If you have an emergency and get care from an out-of-network provider or facility, you can only be charged your in-network cost share.
You cannot be balance billed—even after you’re stable—unless you give written consent to be billed out-of-network (you never have to).

Certain Services at In-Network Hospitals or Surgical Centers

Even at in-network facilities, some providers may be out-of-network (examples: emergency medicine, anesthesia, radiology, lab work, neonatology, surgery assistance, or hospitalist care).
These providers cannot balance bill you. You only pay your in-network share.
For other services, you can only be balance billed if you sign a consent form.

You only pay your normal in-network share (copay, coinsurance, deductible).
Your health plan must pay the rest directly to the out-of-network provider.
Emergency services are covered without prior authorization.
Any payments you make for covered services must count toward your deductible and out-of-pocket maximum.

You can: