Rights and Protections Against Surprise Medical Bills

When balance billing isn't allowed, you also have the following protections:

  • You’re only responsible for paying your share of the cost (like 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)
    • cover emergency services by out-of-network providers
    • 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
    • count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit

This disclosure does not apply to Medicare and Medicaid coverages.