Surprise Medical Billing
Your Rights and Protections Against Surprise Medical Bills
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
What is Balance Billing?
When you see an out-of-network provider at an in-network facility, you may receive a separate bill from that provider. This is called “balance billing.” Balance billing occurs when a provider bills you for the difference between what your insurance pays and the full amount the provider charges.
Protections for Emergency Services
If you receive emergency services from an out-of-network provider, you cannot be balance billed. You will only owe your normal cost-sharing amount (such as copayments, coinsurance, and deductibles).
Protections at In-Network Facilities
If you receive non-emergency care from an out-of-network provider at an in-network hospital or ambulatory surgical center, you cannot be balance billed for those services.
Your Patient Rights
- You have the right to receive a notice before receiving care explaining your balance billing protections
- You have the right to ask your healthcare provider if they are in-network or out-of-network before receiving care
- You have the right to request an in-network provider when possible
- You have the right to appeal a surprise bill
Questions or More Information
For questions about your rights and protections against surprise medical bills, visit www.cms.gov/nosurprises or call 1-800-985-3059.