No Surprises Act Notice

Your Rights and Protections Against Surprise Medical Bills

When you get emergency care or get 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.

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

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.

 

You are protected from balance billing for:

Emergency services

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.

When balance billing isn’t allowed, you also have the following protections:

  • You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
  • Your health plan generally must:
  • Cover emergency services without requiring you to get approval for services in advance (prior authorization).
  • Cover emergency services by out-of-network providers.
  • 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 deductible and out-of-pocket limit.

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.

Addendum – Contact Information by State

 

State Who to Contact & Where to Find Information about Your Rights
Alabama Alabama Department of Insurance

1-334-269-3550

https://www.aldoi.gov/

Arizona Arizona Department of Insurance and Financial Institutions

1-602-364-3100

https://difi.az.gov/

 

Visit https://difi.az.gov/soonbdr for more information about your rights under Arizona state law.

California California Department of Insurance

1-800-927-4357

https://www.insurance.ca.gov/

 

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 Colorado Division of Insurance

1-800-930-3745

https://doi.colorado.gov/for-consumers/file-a-complaint

 

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 Connecticut Insurance Department

1-800-203-3447

https://portal.ct.gov/CID

 

Visit https://portal.ct.gov/CID/General-Consumer-Information/No-Surprises-Act for more information about your rights under Connecticut state law.

Delaware Delaware Department of Insurance

1-800-282-8611

https://insurance.delaware.gov/

 

Visit https://delaware.gov/ for more information about your rights under Delaware state law.

 

Florida Florida Department of Financial Services

1-877-693-5236

https://www.myfloridacfo.com/

 

Visit https://myfloridacfo.com/Division/Consumers/ for more information about your rights under Florida state law.

Georgia Georgia Office of Insurance and Safety Fire

1-800-656-2298

https://oci.georgia.gov/

 

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 Idaho Department of Insurance

1-208-334-4250

https://doi.idaho.gov/

Illinois Illinois Department of Insurance

1-877-527-9431

https://www2.illinois.gov/sites/insurance/Pages/default.aspx

 

Visit http://www.healthcarereportcard.illinois.gov/contents/view/fair_patient_billing_act for more information about your rights under Illinois state law.

Indiana Indiana Department of Insurance

1-800-622-4461

https://www.in.gov/idoi/consumer-services/

 

Visit https://www.in.gov/idoi/ for more information about your rights under Indiana state law.

Iowa Iowa Insurance Division

1-515-654-6600

https://iid.iowa.gov/no-surprises-act

 

Visit https://iid.iowa.gov/ for more information about your rights under Iowa state law.

Kansas Kansas Insurance Department

1-800-432-2484

https://insurance.kansas.gov/

 

Kentucky Kentucky Department of Insurance

1-800-695-6053

https://insurance.ky.gov/ppc/new_default.aspx

Louisiana Louisiana Department of Insurance

1-800-259-5300

https://www.ldi.la.gov/

Maryland 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

[email protected]

Website: http://www.marylandattorneygeneral.gov/Pages/CPD/HEAU

 

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

Fax: (410)468-2260

Website: http://www.insurance.maryland.gov

 

Visit https://www.marylandattorneygeneral.gov/ or https://insurance.maryland.gov/Pages/default.aspx  for more information about your rights under Maryland state law.

Massachusetts Massachusetts Division of Insurance

Consumer Service Unit

1-877-563-4467

https://www.mass.gov/orgs/division-of-insurance

 

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 Michigan Department of Insurance and Financial Services

1-833-275-3437

https://www.michigan.gov/difs/

 

Visit https://www.michigan.gov/difs/0,5269,7-303–560598–,00.html for more information about your rights under Michigan state law.

 

Minnesota Minnesota Department of Health

1-888-345-0823

https://www.health.state.mn.us/index.html

 

Minnesota Department of Commerce

1-800-657-3602

https://mn.gov/commerce/

 

Visit https://mn.gov/commerce/ for more information about your rights under Minnesota state law.

Mississippi Mississippi Insurance Department

1-800-562-2957

https://www.mid.ms.gov/default.aspx

 

Visit https://www.midhelps.org/insurance-guide/balance-billing/ for more information about your rights under Mississippi state law.

Missouri Missouri Department of Commerce & Insurance

1-800-726-7390

https://insurance.mo.gov/index.php

 

Visit https://insurance.mo.gov/consumers/health/external-arbitration-process.php for more information about your rights under Missouri state law.

Montana Montana Office of the Montana State Auditor

Commissioner of Securities and Insurance

1-800-332-6148

https://csimt.gov/

Nebraska Nebraska Department of Insurance

1-877-564-7323

https://doi.nebraska.gov/

 

Visit https://doi.nebraska.gov/sites/doi.nebraska.gov/files/doc/ConsumerFactSheetBalanceBillingandOutofNetworkProviders.pdf for more information about your rights under Nebraska state law.

Nevada Nevada Department of Business and Industry

Division of Insurance

1-888-872-3234

https://doi.nv.gov/

 

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 New Hampshire Insurance Department

1-800-852-3416

https://www.nh.gov/insurance/

 

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 New Jersey Department of Banking & Insurance

1-800-446-7467

https://www.nj.gov/dobi/index.html

 

Visit https://www.nj.gov/dobi/division_consumers/insurance/outofnetwork.html for more information about your rights under New Jersey state law.

New Mexico New Mexico Office of Superintendent of Insurance

Managed Care Bureau

1-855-427-5674

https://www.osi.state.nm.us/

 

Visit https://www.osi.state.nm.us/ for more information about your rights under New Mexico state law.

New York New York State Department of Insurance

1-800-342-3736

http://www.dfs.ny.gov

 

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 North Carolina Department of Insurance

1-855-408-1212

https://www.ncdoi.gov/

Ohio Ohio Department of Insurance

1-800-686-1526

https://insurance.ohio.gov/home

 

Visit https://insurance.ohio.gov/strategic-initiatives/surprise-billing for more information about your rights under Ohio state law.

Oklahoma Oklahoma Insurance Department

1-800-522-0071

https://www.oid.ok.gov/

 

Oregon Oregon Division of Financial Regulation

Phone: 888-877-4894 (toll-free)

Email: DF[email protected]

Website: https://dfr.oregon.gov/help/complaints-licenses/Pages/file-complaint.aspx

 

Visit https://www.oregon.gov/newsroom/pages/NewsDetail.aspx?newsid=64697 for more information about your rights under Oregon state law.

Pennsylvania Pennsylvania Department of Insurance

Consumer Services

1-877-881-6388

https://www.insurance.pa.gov/Coverage/health-insurance/no-surprises-act/Pages/default.aspx

 

Visit https://www.insurance.pa.gov/ for more information about your rights under Pennsylvania state law.

Rhode Island Rhode Island Department of Business Regulation

Insurance Division

401-462-9500

https://dbr.ri.gov/divisions/insurance/

 

Visit https://dbr.ri.gov/ for more information about your rights under Rhode Island state law.

South Carolina South Carolina Department of Insurance

1-803-737-6160

https://www.doi.sc.gov/

South Dakota South Dakota Department of Labor and Regulation

Division of Insurance

605-773-3563

https://dlr.sd.gov/insurance/

Tennessee Tennessee Department of Commerce and Insurance

1-800-342-4029

https://www.tn.gov/commerce/insurance-division.html

Texas Texas Department of Insurance

1-800-252-3439

https://www.tdi.texas.gov/index.html

 

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 Virginia State Corporation Commission

Bureau of Insurance

1-877-310-6560

https://scc.virginia.gov/pages/File-Complaint-Consumers

 

Visit https://scc.virginia.gov/pages/Balance-Billing-Protection for more information about your rights under Virginia state law.

Washington Washington State Office of the Insurance Commissioner

1-800-562-6900

https://www.insurance.wa.gov/file-complaint-or-check-your-complaint-status

 

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 West Virginia Offices of the Insurance Commissioner

1-888-879-9842

https://www.wvinsurance.gov/

 

Visit https://www.wvinsurance.gov/ for more information about your rights under West Virginia state law.

Wisconsin Wisconsin Office of the Commissioner of Insurance

1-800-236-8517

https://oci.wi.gov/pages/homepage.aspx

Wyoming Wyoming Department of Insurance

1-307-777-7402

https://doi.wyo.gov/home

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