When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other 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” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay 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 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 have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.
If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments, deductibles, and/or coinsurance). 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.
Certain services at an in-network hospital or ambulatory surgical center
When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. 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 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 care out-of-network. You can choose a provider or facility in your plan’s network.
If you believe you’ve been wrongly billed, you may file a complaint with the federal government at https://www.cms.gov/nosurprises/consumers or by calling 1-800-985-3059. You may also contact the applicable state enforcement authorities, including those identified in the attached addendum, as applicable.
Visit https://www.cms.gov/nosurprises/consumers for more information about your rights under federal law.
Visit the website identified in the attached addendum for more information about your rights under state law, where applicable.
|Who to Contact & Where to Find Information about Your Rights
|Alabama Department of Insurance
|Arizona Department of Insurance and Financial Institutions
Visit https://difi.az.gov/soonbdr for more information about your rights under Arizona state law.
|California Department of Insurance
Visit https://www.insurance.ca.gov/01-consumers/110-health/60-resources/NoSupriseBills.cfm for more information about your rights under California state law.
|Colorado Division of Insurance
Visit https://doi.colorado.gov/insurance-products/health-insurance/health-insurance-initiatives/out-of-network-health-care for more information about your rights under Colorado state law.
|Connecticut Insurance Department
Visit https://portal.ct.gov/CID/General-Consumer-Information/No-Surprises-Act for more information about your rights under Connecticut state law.
|Delaware Department of Insurance
Visit https://delaware.gov/ for more information about your rights under Delaware state law.
|Florida Department of Financial Services
Visit https://myfloridacfo.com/Division/Consumers/ for more information about your rights under Florida state law.
|Georgia Office of Insurance and Safety Fire
Visit https://oci.georgia.gov/news/2020-12-30/office-commissioner-insurance-and-safety-fire-posts-final-surprise-billing for more information about your rights under Georgia state law.
|Idaho Department of Insurance
|Illinois Department of Insurance
Visit http://www.healthcarereportcard.illinois.gov/contents/view/fair_patient_billing_act for more information about your rights under Illinois state law.
|Indiana Department of Insurance
Visit https://www.in.gov/idoi/ for more information about your rights under Indiana state law.
|Iowa Insurance Division
Visit https://iid.iowa.gov/ for more information about your rights under Iowa state law.
|Kansas Insurance Department
|Kentucky Department of Insurance
|Louisiana Department of Insurance
|Health Education and Advocacy Unit
Office of the Attorney General
200 St Paul Place, 16th Floor
Baltimore, Maryland 21202
Phone: (410) 528-1840 or toll-free 1 (877) 261-8807
En español: 410-230-1712
Fax: (410) 576-6571
Maryland Insurance Administration
Life and Health Complaints Unit
200 St Paul Place, Suite 2700
Baltimore, Maryland 21202
Phone (410) 468-2000 or toll free 1-(800) 492-6116
|Massachusetts Division of Insurance
Consumer Service Unit
Visit https://www.mass.gov/doc/out-of-network-billing-in-massachusetts-chartpack/download for more information about your rights under Massachusetts state law.
|Michigan Department of Insurance and Financial Services
Visit https://www.michigan.gov/difs/0,5269,7-303–560598–,00.html for more information about your rights under Michigan state law.
|Minnesota Department of Health
Minnesota Department of Commerce
Visit https://mn.gov/commerce/ for more information about your rights under Minnesota state law.
|Mississippi Insurance Department
Visit https://www.midhelps.org/insurance-guide/balance-billing/ for more information about your rights under Mississippi state law.
|Missouri Department of Commerce & Insurance
Visit https://insurance.mo.gov/consumers/health/external-arbitration-process.php for more information about your rights under Missouri state law.
|Montana Office of the Montana State Auditor
Commissioner of Securities and Insurance
|Nebraska Department of Insurance
Visit https://doi.nebraska.gov/sites/doi.nebraska.gov/files/doc/ConsumerFactSheetBalanceBillingandOutofNetworkProviders.pdf for more information about your rights under Nebraska state law.
|Nevada Department of Business and Industry
Division of Insurance
Visit https://doi.nv.gov/Consumers/Health_and_Accident_Insurance/Balance_Billing_FAQs/ for more information about your rights under Nevada state law.
|New Hampshire Insurance Department
Visit https://www.nh.gov/insurance/consumers/documents/20211210-nsa-faq-consumers-producers.pdf for more information about your rights under New Hampshire state law.
|New Jersey Department of Banking & Insurance
Visit https://www.nj.gov/dobi/division_consumers/insurance/outofnetwork.html for more information about your rights under New Jersey state law.
|New Mexico Office of Superintendent of Insurance
Managed Care Bureau
Visit https://www.osi.state.nm.us/ for more information about your rights under New Mexico state law.
|New York State Department of Insurance
Visit https://www.dfs.ny.gov/consumers/health_insurance/your_rights_as_a_health_insurance_consumer for more information about your rights under New York state law.
|North Carolina Department of Insurance
|Ohio Department of Insurance
Visit https://insurance.ohio.gov/strategic-initiatives/surprise-billing for more information about your rights under Ohio state law.
|Oklahoma Insurance Department
|Oregon Division of Financial Regulation
Phone: 888-877-4894 (toll-free)
Email: [email protected]
Visit https://www.oregon.gov/newsroom/pages/NewsDetail.aspx?newsid=64697 for more information about your rights under Oregon state law.
|Pennsylvania Department of Insurance
Visit https://www.insurance.pa.gov/ for more information about your rights under Pennsylvania state law.
|Rhode Island Department of Business Regulation
Visit https://dbr.ri.gov/ for more information about your rights under Rhode Island state law.
|South Carolina Department of Insurance
|South Dakota Department of Labor and Regulation
Division of Insurance
|Tennessee Department of Commerce and Insurance
|Texas Department of Insurance
Visit https://www.tdi.texas.gov/tips/texas-protects-consumers-from-surprise-medical-bills.html and https://www.tdi.texas.gov/medical-billing/index.html for more information about your rights under Texas state law.
|Virginia State Corporation Commission
Bureau of Insurance
Visit https://scc.virginia.gov/pages/Balance-Billing-Protection for more information about your rights under Virginia state law.
|Washington State Office of the Insurance Commissioner
Visit https://www.insurance.wa.gov/what-consumers-need-know-about-surprise-or-balance-billing for more information about your rights under Washington state law.
|West Virginia Offices of the Insurance Commissioner
Visit https://www.wvinsurance.gov/ for more information about your rights under West Virginia state law.
|Wisconsin Office of the Commissioner of Insurance
|Wyoming Department of Insurance