Billing Resources

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.