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.<\/p>\n\n\n\n
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\u2019t in your health plan\u2019s network.<\/p>\n\n\n\n
\u201cOut-of-network\u201d describes providers and facilities that haven\u2019t 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 \u201cbalance billing.\u201d This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.<\/p>\n\n\n\n
\u201cSurprise billing\u201d is an unexpected balance bill. This can happen when you can\u2019t control who is involved in your care \u2013 like when you have an emergency or when you schedule a visit at an in-network facility bat are unexpectedly treated by an out-of-network provider.<\/p>\n\n\n\n
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 for your plan\u2019s in-network cost-sharing amount (such as copayments and coinsurance). You can\u2019t 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 balance billed for these post-stabilization services.<\/p>\n\n\n\n
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\u2019s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist.<\/p>\n","protected":false},"excerpt":{"rendered":"
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 \u201cbalance billing\u201d (sometimes called \u201csurprise billing\u201d)? When you see a doctor or other health care provider,…<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_seopress_robots_primary_cat":"","_seopress_titles_title":"","_seopress_titles_desc":"","_seopress_robots_index":"","fname":"","lname":"","position":"","credentials":"","footnotes":""},"service_tags":[],"_links":{"self":[{"href":"https:\/\/pentadocs.com\/wp-json\/wp\/v2\/pages\/1749"}],"collection":[{"href":"https:\/\/pentadocs.com\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/pentadocs.com\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/pentadocs.com\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/pentadocs.com\/wp-json\/wp\/v2\/comments?post=1749"}],"version-history":[{"count":0,"href":"https:\/\/pentadocs.com\/wp-json\/wp\/v2\/pages\/1749\/revisions"}],"wp:attachment":[{"href":"https:\/\/pentadocs.com\/wp-json\/wp\/v2\/media?parent=1749"}],"wp:term":[{"taxonomy":"service_tags","embeddable":true,"href":"https:\/\/pentadocs.com\/wp-json\/wp\/v2\/service_tags?post=1749"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}