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Your Rights and Protections Against Surprise Medical Bills

When you get emergency care or are 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.

请看更新后的 Notice Regarding Patient Protections Against Surprise Billing.

What is "balance billing" (sometimes called "surprise billing")?

当你去看医生或其他医疗保健提供者时, 你可能需要支付一些自付费用, 比如共同支付, 共同保险, 和/或免赔额. You may have other costs or have to pay the entire bill if you see a provider or visit a healthcare facility that isn't in your health plan's network.

"Out-of-network" describes providers and facilities that haven't signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. 这被称为“余额结算”." This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.

“意外账单”是指意外的余额账单. This can happen when you can't control who is involved in your care-like when you have an emergency or when you schedule a visit at an in­ network facility but are unexpectedly treated by an out-of-network provider.

您将免受以下方面的结余计费保护:

紧急服务
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 共同保险). 你不能为这些紧急服务结清帐单. 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 balanced billed for these post-stabilization services.

Certain services at an in-network hospital or ambulatory surgical center
When you get services from an in-network hospital or ambulatory surgical center, 某些提供商可能不在网络中. In these cases, the most those providers may bill you is your plan's in-network cost-sharing amount. 这适用于急诊医学, 麻醉, 病理, 放射学, 实验室, 新生儿学, 助理外科医生, hospitalist, 或者重症监护服务. These providers can't balance bill you and may not ask you to give up your protections not to be balance billed.

If you get other services at these in-network facilities, out-of-network providers can't balance bill you, unless you give written consent and give up your protections.

You're never required to give up your protections from balance billing. 您也不需要获得网络外的护理. You can choose a provider or facility in your plan's network.

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, 共同保险, 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.
  • 您的健康计划通常必须:
    • Cover emergency services without requiring you to get approval for services in advance (prior authorization).
    • 覆盖网络外供应商提供的紧急服务.
    • 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.

如果你认为你被冤枉了, you may contact the “No Surprises Helpdesk” at 1-800-985-3059 or the Nebraska Department of Insurance at 1-877-564-7323.

Visit http://www.cms.gov/nosurprises 了解更多有关您在联邦法律下的权利