Billing Resources

Emergency Medical Specialists provides patient education information to help patients understand and manage Emergency Medicine healthcare billing process through a variety of resources, such as Notice of Privacy Practices (NPP), The No Surprises Act (NSA), and Good Faith Estimate (GFE). View the disclosures below.

Disclosures

The No Surprises Act (NSA)

Your Rights and Protections Against Surprise Medical Bills

(The No Surprises Act/NSA)

When you obtain emergency care or are treated by an out-of network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you should not be charged more than your plan’s copayment, coinsurance, and/or deductible.

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, or deductible. 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’t in your health plan’s network.

“Balance billing” is when an out-of-network provider bills you for the difference between what your plan agreed to pay and the full amount charged for a service, excluding any co-payments-co-insurance or deductible responsibilities. This could leave you with an unexpected bill.

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 (e.g., copay, coinsurance, deductible).
    • You cannot be balance billed for these 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, excluding any co-payments-co-insurance or deductible responsibilities, this does not fall under balance billing.
    • You cannot be balance by these providers.

You are never required to give up your protection from balance billing. You also aren’t required to get care from an out-of-network provider or facility. You can choose a provider or facility in your health plan’s network.

If you believe you’ve been wrongly billed, you can contact the No Surprises Help Desk at 1-800-985-3059 or visit www.cms.gov/nosurprises for more information.