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, you are protected from surprise billing or balance billing.

One of these protections is your right to a Good Faith Estimate.
See the Good Faith Estimate under the About tab on this website for more information.

What is “balance billing” (sometimes called “surprise billing”)?

When you see a doctor or other health care provider, you may owe out-of-pocket costs like a copayment, coinsurance, and/or a deductible.
You may have other costs or need to pay the full bill if the provider or facility is not in your health plan’s network.

  • Out-of-network providers and facilities have not signed a contract with your plan.

  • They may charge you the difference between what your plan paid and the full service cost — this is called balance billing.

  • Balance billing is usually higher than in-network costs and might not count toward your annual out-of-pocket limit.

Surprise billing is an unexpected balance bill — often happening when:

  • You can’t control who provides your care (e.g., during emergencies).

  • You’re treated by an out-of-network provider at an in-network facility without knowing.

You are protected from balance billing for:

Emergency Services

If you experience an emergency medical condition and get care from an out-of-network provider or facility, you can only be billed your in-network cost-sharing amount (copayments, coinsurance, etc.).

  • You cannot be balance billed for these services.

  • This includes care you receive after stabilization, unless you provide written consent to be balance billed.

[Insert plain language summary of any applicable state balance billing laws or requirements OR state-developed model language as appropriate]

Certain Services at an In-Network Hospital or Ambulatory Surgical Center

When treated at an in-network hospital or surgical center, some providers (e.g., anesthesiologists, radiologists) may be out-of-network.

In these cases:

  • The most they may bill you is your plan’s in-network cost-sharing amount.

  • This protection applies to services like:

    • Emergency medicine

    • Anesthesia

    • Pathology

    • Radiology

    • Laboratory

    • Neonatology

    • Assistant surgery

    • Hospitalist services

    • Intensive care services

These providers cannot balance bill you or ask you to waive your protections.

If you receive other services from out-of-network providers at in-network facilities, they also cannot balance bill you unless you give written consent to do so.

Your Choice Matters

  • You are never required to give up your protections from balance billing.

  • You are not obligated to seek care out-of-network.

  • You can always choose a provider or facility within your health plan’s network.

If You Believe You’ve Been Wrongly Billed

You may contact the Center for Mental Health Services of the U.S. Department of Health and Human Services:

1-800-985-3059
Visit the No Surprises website

Here, you can learn more about your rights under federal law and get help with the dispute resolution process.