When getting emergency care or treatment from an out-of-network provider at an in-network hospital or ambulatory surgical center, the No Surprises Act – a federal law that took effect at the beginning of 2022 – protects you from balance billing and surprise billing.
Understanding balance billing and surprise billing
When you see a doctor or other health care provider, 你可能会有一些自付费用, 包括共同支付, 共同保险或免赔额. You may have other costs or need to pay the entire bill if you see a provider or visit a facility that isn't in your health plan's network.
Out-of-network providers and facilities are those that haven't signed a contract with your health plan. Balance billing occurs when out-of-network providers or facilities bill you for the difference between what your plan agreed to pay and the full amount they charge for a service. This payment might not count toward your annual out-of-pocket limit. Surprise billing is when you receive an unexpected balance bill.
Balance billing and surprise billing can happen when you can't control who is involved in your care – such as when you need emergency services or schedule a visit at an in-network facility but unexpectedly receive treatment from an out-of-network provider.
You are protected from balance billing for emergency services as well as for certain services at an in-network hospital or ambulatory surgical center.
紧急服务
If you have an emergency medical condition and receive emergency care 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 (such as a copayment or coinsurance). You cannot be balance billed for emergency services. This includes care you get after your condition stabilizes, unless you provide written consent giving up your protections against being balanced billed for post-stabilization services.
Certain services at an in-network health care facility
When you get services from an in-network hospital or ambulatory surgical center, some members of your care team may be out-of-network providers. In these cases, the most those providers can bill is your plan's in-network cost-sharing amount. This applies to providers in emergency medicine, 麻醉, 病理, 放射学, 实验室服务, 新生儿学, 助理外科十大赌博平台排行榜服务, 以及十大赌博平台排行榜或重症监护服务. These providers can't balance bill you or ask you to give up your protections against balance billing.
If you get other services at in-network facilities, out-of-network providers can't balance bill you unless you provide written consent giving up your protections. There are no circumstances under which you are required to give up your protections from balance billing or get out-of-network care.
California state law has similar protections to those of the No Surprises Act.
Protections when balance billing is prohibited
当禁止余额结算时, you are responsible only for your share of the cost of the care you received. 这可能包括共同付款, coinsurance and deductibles that you would pay with an in-network provider or facility. Your health plan will pay out-of-network providers and facilities directly, and you shouldn't have to pay out of pocket for more than your share of the cost.
Your health plan generally must provide the following protections:
- Cover emergency services without requiring approval 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
- Count the amount you pay for emergency or out-of-network services toward your deductible and out-of-pocket maximum
如果你认为你被冤枉了
如果你认为你被冤枉了 for care you received from a 加州大学旧金山分校健康 facility, 请把帐单询价寄过来 加州大学旧金山分校健康的MyChart.
For more information on your rights under federal law, visit the Centers for Medicare & 医疗服务的 关于《十大赌博平台排行榜》的网页.
For more information on your medical billing rights under California state law, visit the California Department of 保险's 关于意外医疗账单的网页 or call the California Department of Managed Health Care at (888) 466-2219.