YOU HAVE THE RIGHT TO RECEIVE A "GOOD FAITH ESTIMATE" EXPLAINING HOW MUCH YOUR MEDICAL CARE WILL COST
Notice to clients and prospective clients: Under the law, health care providers need to give clients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services. You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services. You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service, or at any time during treatment. If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, or how to dispute a bill, see your Estimate, or visit www.cms.gov/nosurprises.
YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLS (OMB Control Number: 0938-1401)
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.
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs,such as a copayment, coinsurance, and/or a deductible. You may have other costs or have topay the entire bill if you see a provider or visit a health care facility that isn’t in your healthplan’snetwork.
“Out-of-network” describes providers and facilities that haven’t signed a contract with yourhealth plan. Out-of-network providers may be permitted to bill you for the difference betweenwhat your plan agreed to pay and the full amount charged for a service. This is called “balancebilling.” This amount is likely more than in-network costs for the same service and might notcounttowardyourannualout-of-pocketlimit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who isinvolved in your care - like when you have an emergency or when you schedule a visit at an in-networkfacilitybutareunexpectedlytreatedbyanout-of-networkprovider.
Youareprotectedfrombalancebillingfor: Emergencyservices If you have an emergency medical condition and get emergency services 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 copayments and coinsurance). You can’t be balancebilled for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balancedbilledforthesepost-stabilizationservices.
Certainservicesatanin-networkhospital orambulatorysurgicalcenter When you get services from an in-network hospital or ambulatory surgical center, certainproviders there may be out-of-network. In these cases, the most those providers may bill you isyour plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia,pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivistservices. These providers can’t balance bill you and may not ask you to give up your protections nottobebalancebilled.
If you get other services at these in-network facilities, out-of-network providers can’t balance billyou unlessyougivewrittenconsentandgiveupyourprotections.
You’re never required to give up your protection from balance billing. You alsoaren’t required to get care out-of-network. You can choose a provider or facilityinyourplan’snetwork.
When balance billing isn’t allowed, you also have the following protections:
You are 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).Yourhealthplanwillpayout-of-networkprovidersandfacilitiesdirectly.
Your health plan generally must:
Cover emergency services without requiring you to get approval for services inadvance(priorauthorization).
Basewhatyouowetheproviderorfacility(cost-sharing)on whatitwouldpayanin-network provider or facility and show that amount in your explanation ofbenefits.
Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.
If you believe you’ve been wrongly billed, you may contact: 303-894-7490 / 800-930-3745(outside the Denver Metro area) / DORA_Insurance@state.co.usOR in California please contact the California Department of Insurance Help Center online or call at 1-800-927-4357