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Patient Rights

No Surprises Act

Your rights and protections against surprise medical bills — explained clearly.

You are protected by federal law

Balance billing protections apply

Good Faith Estimates available

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“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.”
UNDERSTANDING YOUR BILL

What Is Balance Billing?

Insurance language can be confusing. Here are the terms you are most likely to encounter — explained in plain language.

What Does Out-of-Network Mean?

Providers and facilities that have not signed a contract with your health plan. They may bill you the difference between what your plan pays and their full charge; this is balance billing.
OUT-OF-NETWORK

What Is Balance Billing?

When an out-of-network provider bills you for the difference between their charge and what your insurance pays. This amount is often higher than in-network costs and may not count toward your out-of-pocket limit.
BALANCE BILLING

What Is Surprise Billing?

An unexpected balance bill — this can happen in emergencies or when an out-of-network provider treats you at an in-network facility without your knowledge.

SURPRISE BILLING
YOUR PROTECTIONS

You Are Protected From Balance Billing For:

Federal law protects you from surprise billing in the following situations:

Emergency Services

If you have an emergency medical condition and receive emergency services from an out-of-network provider or facility, the most they may bill you is your plan’s in-network cost-sharing amount (copayments and coinsurance).

 

This includes services after you are stabilized, unless you give written consent to be balance billed for post-stabilization services.

Emergency Services

When you receive care at an in-network hospital or ambulatory surgical center, certain out-of-network providers there may not balance bill you. This applies to: emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, and intensivist services.

 

You are never required to give up your balance billing protections. You always have the right to choose an in-network provider.

When Balance Billing Is Not Allowed, You Also Have These Protections:

  • You are only responsible for your share of costs — copayments, coinsurance, and deductibles — as if the provider was in-network. Your health plan pays out-of-network providers directly.
  • Your health plan must cover emergency services without requiring prior authorization.
  • Your health plan must base your cost-sharing on in-network rates and show that amount in your Explanation of Benefits (EOB).
  • Any amount you pay for emergency or out-of-network services must count toward your deductible and out-of-pocket limit.

Believe you have been wrongly billed?

Contact our billing specialist Angie directly.

Call: (402) 580-9503
UNINSURED / SELF-PAY

Good Faith Estimate Notice

Under federal law, health care providers must give uninsured patients or those not using insurance a written estimate of expected costs before services are provided.

Your Right to an Estimate

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services — including medical tests, prescription drugs, equipment, and hospital fees.
1

Timing Requirements

Your health care provider must give you a Good Faith Estimate in writing at least 1 business day before your service or item. You can also request one before scheduling any service.
2

Dispute Rights

If you receive a bill that is at least $400 more than your Good Faith Estimate, you have the right to dispute the bill.
3

Keep Your Estimate

Make sure to save a copy or take a photo of your Good Faith Estimate for your records.
4

Federal Resources

For more information about your rights, visit the CMS No Surprises Act page.

Call: (402) 580-9503

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