Patients are protected from surprise bills when they receive:
- Out-of-network emergency services, including air ambulance (but not ground ambulance)Covered medical items and services performed by an OON provider at an INN facility (unless the provider follows the notice and consent process described above).
- Out-of-network non-emergency, ancillary services* provided at in-network facility.
- Non-emergency, non-ancillary services provided at in-network facility, and the provider did not get your prior consent in the way the No Surprises act requires.
And, for the above services, the health plan must ensure that the patient’s cost-share (in other words, coinsurance, copay, deductible):
- Is the same as it would have been if the service was provided in-network. Out-of-network non-emergency, ancillary services* provided at in-network facility.
- Is based on what the plan would pay an in-network provider.
- Counts toward the patient’s in-network deductible.
- Counts toward the patient’s out-of-pocket maximum.
*Ancillary services include services related to emergency medicine, anesthesiology, pathology, radiology and neonatology; certain diagnostic services (including radiology and laboratory services); items and services provided by other specialty practitioners; and items and services provided by an out-of-network provider if there is no in-network provider that can provide that service.
Remember: In-network providers are not allowed to balance bill. If you are asked to give up your protections against surprise billing through the Notice and Consent form, you have options. Contact your health plan for help finding an in-network option.