No Surprises Act and balance billing rights

You are protected from balance billing for:

Emergency services

If you receive emergency care from an out-of-network provider or facility, the most that provider or facility may bill you is your plan's in-network cost-sharing amount. This applies even if you get emergency services from an out-of-network provider or facility, and includes services you may get after you're in stable condition, unless you give written consent and give up your protections not to be balance 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 cannot 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 cannot balance bill you unless you give written consent and give up your protections.

Air ambulance services

When you use an out-of-network air ambulance provider, the most that provider may bill you is your plan's in-network cost-sharing amount.

You are 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 (such as 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).
• Your health plan generally must cover emergency services by out-of-network providers.
• Your health plan generally must 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.
• Your health plan generally must count any amount you pay for emergency services or out-of-network services described above toward your deductible and out-of-pocket limit.

If you believe you've been wrongly billed, you may contact:

• U.S. Centers for Medicare & Medicaid Services (CMS): 1-800-985-3059

Visit www.cms.gov/nosurprises for more information about your rights under federal law.