Your Rights & Protections Against Surprise Medical Bills
Federal law protects patients from surprise medical bills, also known as balance billing, in certain situations.
What is balance billing?
Balance billing happens when a patient is charged the difference between what an insurance plan pays and the provider’s full charge. This can occur when care is received from a provider or facility that is not in a patient’s insurance network. Surprise billing often happens when patients cannot choose who provides part of their care.
When you are protected
You are protected from balance billing in the following situations:
- Emergency care
If you receive emergency services, you cannot be charged more than your in-network cost-sharing amount, even if the provider or facility is out of network. - Certain services at in-network facilities
When you receive care at an in-network hospital or ambulatory surgical center, you are protected from surprise bills from certain out-of-network providers involved in your care, such as emergency medicine, anesthesia, radiology, pathology, laboratory services, and hospital-based physicians.
In these situations, providers may not bill you beyond what you would normally owe for in-network care, and you are not required to waive these protections.
Additional protections
When balance billing is not allowed:
- You are only responsible for your usual cost-sharing amounts.
- Your health plan pays the remaining balance directly to the provider.
- Amounts you pay count toward your in-network deductible and out-of-pocket limits.
Questions or concerns
If you believe you were billed incorrectly, help is available.
For more information about your rights under the No Surprises Act, visit the Centers for Medicare & Medicaid Services (CMS):
https://www.cms.gov/nosurprises
