{"id":2399,"date":"2024-11-19T10:46:12","date_gmt":"2024-11-19T16:46:12","guid":{"rendered":"https:\/\/healthy-connections.org\/?page_id=2399"},"modified":"2025-02-04T16:15:30","modified_gmt":"2025-02-04T22:15:30","slug":"patient-protections-against-surprise-billing","status":"publish","type":"page","link":"https:\/\/healthy-connections.org\/patient-protections-against-surprise-billing\/","title":{"rendered":"Patient Protections Against Surprise Billing"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"2399\" class=\"elementor elementor-2399\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-cae3d27 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"cae3d27\" data-element_type=\"section\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-e6b2398\" data-id=\"e6b2398\" data-element_type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-23d8b61 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"23d8b61\" data-element_type=\"section\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-dc7e8c3\" data-id=\"dc7e8c3\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-1d52909 elementor-widget elementor-widget-heading\" data-id=\"1d52909\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Your Rights and Protections Against Surprise Medical Bills<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-eaaee0f\" data-id=\"eaaee0f\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-350b318 elementor-widget elementor-widget-image\" data-id=\"350b318\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"1024\" height=\"681\" src=\"https:\/\/healthy-connections.org\/wp-content\/uploads\/2024\/11\/AdobeStock_502706059-1024x681.jpeg\" class=\"attachment-large size-large wp-image-2406\" alt=\"A young man talks to a front desk worker about Patient Protection against Surprise Billing.\" srcset=\"https:\/\/healthy-connections.org\/wp-content\/uploads\/2024\/11\/AdobeStock_502706059-1024x681.jpeg 1024w, https:\/\/healthy-connections.org\/wp-content\/uploads\/2024\/11\/AdobeStock_502706059-300x200.jpeg 300w, https:\/\/healthy-connections.org\/wp-content\/uploads\/2024\/11\/AdobeStock_502706059-768x511.jpeg 768w, https:\/\/healthy-connections.org\/wp-content\/uploads\/2024\/11\/AdobeStock_502706059.jpeg 1200w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-24573df gallery-spacing-custom elementor-hidden-mobile elementor-widget elementor-widget-image-gallery\" data-id=\"24573df\" data-element_type=\"widget\" data-widget_type=\"image-gallery.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-image-gallery\">\n\t\t\t<div id='gallery-1' class='gallery galleryid-2399 gallery-columns-2 gallery-size-full'><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon landscape'>\n\t\t\t\t<img decoding=\"async\" width=\"1200\" height=\"800\" src=\"https:\/\/healthy-connections.org\/wp-content\/uploads\/2024\/11\/AdobeStock_319526449.jpeg\" class=\"attachment-full size-full\" alt=\"Young female receptionist working with a patient in clinic about protection against surprise billing.\" srcset=\"https:\/\/healthy-connections.org\/wp-content\/uploads\/2024\/11\/AdobeStock_319526449.jpeg 1200w, https:\/\/healthy-connections.org\/wp-content\/uploads\/2024\/11\/AdobeStock_319526449-300x200.jpeg 300w, https:\/\/healthy-connections.org\/wp-content\/uploads\/2024\/11\/AdobeStock_319526449-1024x683.jpeg 1024w, https:\/\/healthy-connections.org\/wp-content\/uploads\/2024\/11\/AdobeStock_319526449-768x512.jpeg 768w\" sizes=\"(max-width: 1200px) 100vw, 1200px\" \/>\n\t\t\t<\/div><\/figure><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon landscape'>\n\t\t\t\t<img decoding=\"async\" width=\"1200\" height=\"800\" src=\"https:\/\/healthy-connections.org\/wp-content\/uploads\/2024\/11\/AdobeStock_379625084.jpeg\" class=\"attachment-full size-full\" alt=\"Young female receptionist talking on phone in clinic while sitting and looking at surprise billing on her monitor\" srcset=\"https:\/\/healthy-connections.org\/wp-content\/uploads\/2024\/11\/AdobeStock_379625084.jpeg 1200w, https:\/\/healthy-connections.org\/wp-content\/uploads\/2024\/11\/AdobeStock_379625084-300x200.jpeg 300w, https:\/\/healthy-connections.org\/wp-content\/uploads\/2024\/11\/AdobeStock_379625084-1024x683.jpeg 1024w, https:\/\/healthy-connections.org\/wp-content\/uploads\/2024\/11\/AdobeStock_379625084-768x512.jpeg 768w\" sizes=\"(max-width: 1200px) 100vw, 1200px\" \/>\n\t\t\t<\/div><\/figure>\n\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-6fcc6ca elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"6fcc6ca\" data-element_type=\"section\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-e8e3729\" data-id=\"e8e3729\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-440f8c3 elementor-section-full_width elementor-section-height-default elementor-section-height-default\" data-id=\"440f8c3\" data-element_type=\"section\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-e09e4cf\" data-id=\"e09e4cf\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3e67c33 elementor-widget elementor-widget-heading\" data-id=\"3e67c33\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">What is \u201cbalance billing\u201d (sometimes called \u201csurprise billing\u201d)?\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2e97a5e elementor-widget elementor-widget-text-editor\" data-id=\"2e97a5e\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a home health care facility that isn\u2019t in your health plan\u2019s network.<br \/><br \/>\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.\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.<br \/><br \/>\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 dollars depending on the procedure or service.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-a3fb276 elementor-section-full_width elementor-section-height-default elementor-section-height-default\" data-id=\"a3fb276\" data-element_type=\"section\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-b1056a7\" data-id=\"b1056a7\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-542391f elementor-widget elementor-widget-heading\" data-id=\"542391f\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">You\u2019re protected from balance billing for:<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f76e9dc elementor-widget elementor-widget-text-editor\" data-id=\"f76e9dc\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><strong>Emergency services:<\/strong> 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 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>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-4c5b9e1 elementor-widget elementor-widget-text-editor\" data-id=\"4c5b9e1\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><strong>Certain services at an in-network hospital or ambulatory surgical center:<\/strong> 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 can 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 services. These providers can\u2019t balance bill you and may not ask you to give up your protections not to be balance billed.<br \/><br \/>If you get other types of services at these in-network facilities, out-of-network providers can\u2019t balance bill you unless you give written consent and give up your protections.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3a802b0 elementor-widget elementor-widget-text-editor\" data-id=\"3a802b0\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><b>You\u2019re <\/b><b>never<\/b><b> 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 in your plan\u2019s network.<\/b><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9c16f65 elementor-widget elementor-widget-text-editor\" data-id=\"9c16f65\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><b>When balance billin<\/b><b>g<\/b><b> isn\u2019t allowed, you also have these protections:<\/b><\/p><p><span style=\"font-weight: 400;\">You\u2019re only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.<br \/><br \/><\/span><\/p><p><span style=\"font-weight: 400;\">Generally, your health plan must:<\/span><\/p><ul><li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Cover emergency services without requiring you to get approval for services in advance (also known as \u201cprior authorization\u201d).<\/span><\/li><li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Cover emergency services by out-of-network providers.<\/span><\/li><li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">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.<\/span><\/li><li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Count any amount you pay for emergency services or out-of-network services toward your in-network deductible and out-of-pocket limit.<\/span><\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a5332f6 elementor-widget elementor-widget-text-editor\" data-id=\"a5332f6\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><b>If you think you\u2019ve been wrongly billed, <\/b><span style=\"font-weight: 400;\">contact the U.S. Department of Health and Human Services (HHS) in coordination with the Department of the Treasury, Department of Labor, and the Office of Personnel Management. The federal phone number for information and complaints is <a href=\"tel:8009853059;ext=1\">1-800-985-3059<\/a>.<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d5a04df elementor-widget elementor-widget-text-editor\" data-id=\"d5a04df\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><span style=\"font-weight: 400;\">Visit<\/span> <a href=\"http:\/\/www.cms.gov\/nosurprises\/consumers\" target=\"_blank\" rel=\"noopener\"><i><span style=\"font-weight: 400;\">www.cms.gov\/nosurprises\/consumers <\/span><\/i><\/a><span style=\"font-weight: 400;\">for more information about your rights under federal law.<br \/><br \/><\/span><\/p><p><span style=\"font-weight: 400;\">LabCorp reference laboratory \u201cGood Faith Estimator\u201d can be located on the LabCorp portal at <\/span><a href=\"http:\/\/www.labcorplink.com\/\" target=\"_blank\" rel=\"noopener\"><i><span style=\"font-weight: 400;\">www.LabCorpLINK.com<\/span><\/i><\/a> <span style=\"font-weight: 400;\">for a quote of potential send-out, out-of-pocket laboratory costs.<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Your Rights and Protections Against Surprise Medical Bills Young female receptionist working with patient in clinic Young female receptionist talking on phone in clinic while sitting and looking on pc monitor What is \u201cbalance billing\u201d (sometimes called \u201csurprise billing\u201d)? When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":2371,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"site-sidebar-layout":"no-sidebar","site-content-layout":"page-builder","ast-site-content-layout":"full-width-container","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"disabled","ast-breadcrumbs-content":"","ast-featured-img":"disabled","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"set","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"class_list":["post-2399","page","type-page","status-publish","has-post-thumbnail","hentry"],"rankMath":{"parentDomain":"healthy-connections.org","noFollowDomains":[],"noFollowExcludeDomains":[],"noFollowExternalLinks":false,"featuredImageNotice":"The featured image should be at least 200 by 200 pixels to be picked up by Facebook and other social media sites.","pluginReviewed":false,"postSettings":{"linkSuggestions":true,"useFocusKeyword":false},"frontEndScore":false,"postName":"patient-protections-against-surprise-billing","permalinkFormat":"https:\/\/healthy-connections.org\/%pagename%\/","showLockModifiedDate":true,"assessor":{"focusKeywordLink":"https:\/\/healthy-connections.org\/wp-admin\/edit.php?focus_keyword=%focus_keyword%&post_type=%post_type%","hasTOCPlugin":true,"primaryTaxonomy":false,"serpData":{"title":"Patient Protections Against Balance Billing | %sitename%","description":"You have protections from balance billing in a range of circumstances. 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