{"id":22806,"date":"2022-01-21T16:23:02","date_gmt":"2022-01-21T22:23:02","guid":{"rendered":"https:\/\/aboutsmh.org\/?page_id=22806"},"modified":"2022-01-21T16:31:16","modified_gmt":"2022-01-21T22:31:16","slug":"your-rights-and-protections-against-surprise-medical-bills","status":"publish","type":"page","link":"https:\/\/aboutsmh.org\/your-rights-and-protections-against-surprise-medical-bills\/","title":{"rendered":"Your Rights and Protections Against Surprise Medical Bills"},"content":{"rendered":"\t\t
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What is \"balance billing\" (sometimes called \"surprise billing\")?<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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When you see a doctor or other health care provider, you may owe certain out-of-pocket costs,<\/a> like a copayment, <\/a>coinsurance, <\/a>or deductible<\/a>. 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\u2019t in your health plan\u2019s network.<\/p>

\u201cOut-of-network\u201d means providers and facilities that haven\u2019t 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. This is called \u201cbalance billing<\/strong>.\u201d This amount is likely more than in-network costs for the same service and might not count toward your plan\u2019s deductible or annual out-of-pocket limit.<\/p>

\u201cSurprise billing\u201d is an unexpected balance bill. This can happen when you can\u2019t control who is involved in your care\u2014like 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 dollarsdepending on the procedure or service.<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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You're protected from balance billing for:<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Emergency services<\/h4>

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\u2019s in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). You can\u2019t <\/strong>be balance billed for these emergency services. This includes services you may get after you\u2019re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.<\/p>

To view, download and read the St. Margaret\u2019s Health Financial Assistance Plain Language Summary, please visit ourwebsite at https:\/\/aboutsmh.org\/financial-assistance\/<\/a>.<\/p>

Certain services at an in-network hospital or ambulatory surgical center<\/h4>

When you get services from an in-network hospital or ambulatory surgical center, certain providers there may beout-of-network. In these cases, the most those providers can bill you is your plan\u2019s in-network cost-sharing amount.This applies to emergency medicine, anesthesia,\u00a0pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers\u00a0can\u2019t <\/strong>balance bill you and may not <\/strong>ask you to give up your protections not to be balance billed.<\/p>

If you get other types of services at these in-network facilities, out-of-network providers can\u2019t\u00a0<\/strong>balance bill you, unless you give written consent and give up your protections.<\/p>

You\u2019re never<\/u> required to give up your protections from balance billing. You also aren\u2019t required to get out-of-network care. You can choose a provider or facility <\/strong>in your plan\u2019s network.<\/strong><\/h3>

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To view, download and read the St. Margaret\u2019s Health Financial Assistance Plain Language Summary, please visit ourwebsite at https:\/\/aboutsmh.org\/financial-assistance\/<\/a>.<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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When balance billing isn't allowed, you also have these protections:<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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