你r Rights and Protections Against 惊喜 Medical Bills

When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected 来自余额账单. 在这种情况下，你不应该被收取更多的费用 than your plan’s 共同付费s, 共同保险 and/or 可扣除的.

What is “平衡账单” (sometimes called “surprise 计费”)?

When you see a doctor or other health care provider, you may owe certain 口袋出优先车道成本，像… 共同付费, 共同保险，或者可扣除的. 你 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 计划的网络.

“网外” means 供应商 and facilities that haven’t signed a contract with your health plan to provide services. 网外供应商 may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service. 这叫做"平衡账单”. This amount is likely more than in-network costs for the same service and might 不 count toward your plan’s 可扣除的 or annual 现款支付的限制.

“惊喜 billing” is an unexpected balance bill. 这可以 happen when you 不能 control who is involved in your care-like 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. 惊喜 medical bills could cost thousands of dollars depending on the procedure 或服务.

您可以免受余额账单的保护:

紧急服务

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’s in-network 费用分摊金额 (such as 共同付费s, 共同保险及免赔额). 你不能 be balance billed for these emergency services. 这包括服务 you may get after you’re in stable condition, unless you give written consent and give up your protections 不 to be balanced billed for these post-stabilization服务.

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 供应商 there may be out-of-network. 在这些情况下， the most those 供应商 can bill you is your plan’s in-network 费用分摊金额. This applies to emergency medicine, anesthesia,

pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, 或者重症监护服务. 这些提供者不能平衡你和我的账单不 ask you to give up your protections 不 to be balance billed. 如果你得到 other types of services at these in-network facilities, out-of-network 供应商不能 balance bill you, unless you give written consent and give up your protections.

你从来没有 required to give up your protections 来自余额账单. 你也不是需要获得网络外的医疗服务. 您可以选择供应商或设施在你的计划网络中.

When 平衡账单 isn’t allowed, you also have these protections:

你 only responsible for paying your share of the cost (like the 共同付费s, 共同保险, and 可扣除的 that you would pay if the provider 或者设施在网络中). 你的健康计划会支付额外费用 costs to out-of-network 供应商 and facilities directly.
一般来说，您的健康计划必须:
- Cover emergency services without requiring you to get approval f或服务s in advance (also known as “prior authorization”).
- Cover emergency services by out-of-network 供应商.
- 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 的好处.
- Count any amount you pay for emergency services or out-of-network services toward your in-network 可扣除的 and 现款支付的限制.

If you think you’ve been wrongly billed, contact the federal phone number for information and complaints is: 1-800-985-3059.

访问 http://www.cms.gov / nosurprises /消费者 for more information about your rights under federal law.

免责声明

This Good 信仰估计 shows the costs 它的ems and services that are reasonably expected for our health care needs for an item 或服务. The estimate is based on information known at the time the estimate was created.

The Good 信仰估计 does 不 include any unknown or unexpected costs 这可能在治疗过程中出现. 如果出现并发症，你可能会被收取更多的费用或者出现特殊情况. 如果发生这种情况，联邦法律允许你对议案提出异议(上诉.

If you are billed for more than this Good 信仰估计, you have the 对票据提出异议的权利.

你 may contact the health care provider or facility listed to let them know the billed charges are higher than the Good 信仰估计. 你可以 ask them to update the bill to match the Good 信仰估计, ask to negotiate the bill，或者sk if there is financial assistance available.

你 may also start a dispute resolution process with the U.S. 部门卫生与公众服务部(HHS). 如果您选择使用争议解决 process, you must start the dispute process within 120 calendar days (about 自原汇票日期起计4个月.

使用争议处理程序需要支付25美元的费用. 如果机构审查 your dispute agrees with you, you will have to pay the price on this Good 信仰估计. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.

To learn more and get a form to start the process, go to www.cms.gov / nosurprises 或致电[1-800-985-3059].

For questions or more information about your right to a Good 信仰估计或争议程序，访问 www.cms.gov / nosurprises 或致电[1-800-985-3059].

Keep a copy of this Good 信仰估计 in a safe place or take pictures 它的. 你 may need it if you are billed a higher amount.