Your Rights and Protections Against Surprise Medical Bills

When you receive **emergency care**, or when you’re treated by an **out-of-network provider at an in-network hospital or ambulatory surgical center**, federal law protects you from **surprise bills** (also called **balance billing**). ### What is “balance billing” (sometimes called “surprise billing”)? When you see a doctor or other health care provider, you may be responsible for out-of-pocket costs such as a **copay**, **coinsurance**, and/or a **deductible**. If you receive care from a provider or facility that is **not in your health plan’s network**, you may have additional costs—or be billed for the full amount. * **Out-of-network** providers and facilities do not have a contract with your health plan. * In some situations, out-of-network providers can bill you for the difference between what your plan pays and the provider’s full charge. This is called **balance billing**. * Balance bills are often higher than in-network costs for the same service and may not count toward your annual out-of-pocket maximum. A **surprise bill** is an unexpected balance bill. This can happen when you can’t choose who is involved in your care—such as during an emergency—or when you go to an in-network facility but are unexpectedly treated by an out-of-network provider. --- ## You are protected from balance billing for: ### 1) Emergency services If you have an emergency medical condition and receive emergency services from an out-of-network provider or facility, the most you can be billed is your plan’s **in-network cost-sharing amount** (such as copays and coinsurance). **You cannot be balance billed for emergency services.** This also includes services you receive after you are stable **unless** you provide written consent to give up your protections for certain post-stabilization services. ### 2) Certain services at an in-network hospital or ambulatory surgical center When you get care at an **in-network hospital or ambulatory surgical center**, some providers who treat you there may be **out-of-network**. In these cases, those providers may only bill you your plan’s **in-network cost-sharing amount** for certain services, including: * Emergency medicine * Anesthesia * Pathology * Radiology * Laboratory services * Neonatology * Assistant surgeon * Hospitalist * Intensivist These providers **cannot** balance bill you and **cannot** ask you to waive your protections. If you receive other services at these in-network facilities, out-of-network providers **cannot** balance bill you **unless** you give written consent and give up your protections. --- ## Important: You do not have to waive your rights You are **never required** to give up your protections from balance billing. You also are **not required** to receive care out-of-network—you can choose providers and facilities in your plan’s network. --- ## Additional protections when balance billing isn’t allowed When balance billing is prohibited: * You are only responsible for paying your normal in-network share (copays, coinsurance, and deductibles). * Your health plan will pay out-of-network providers and facilities directly. Your health plan generally must also: * Cover emergency services without requiring prior authorization. * Cover emergency services from out-of-network providers. * Base your cost-sharing on what it would pay an in-network provider/facility and show that amount in your explanation of benefits. * Count what you pay for emergency services or covered out-of-network services toward your deductible and out-of-pocket limit. --- ## If you believe you were billed incorrectly If you believe your billed charges are higher than your **Good Faith Estimate**, you may contact **Vallis Mental Health** to: * Request the bill be updated to match the Good Faith Estimate, * Discuss/negotiated the bill, and/or * Ask whether financial assistance is available. You may also start a dispute resolution process with the **U.S. Department of Health and Human Services (HHS)**. You must begin the dispute process within **120 calendar days** (about 4 months) of the date on the original bill. * There is a **$25 fee** to use the dispute process. * If the reviewing agency agrees with you, you will pay the amount listed on your Good Faith Estimate. * If the agency disagrees and agrees with **Inspirational Counseling LLC**, you may be required to pay the higher amount. ``` To learn more or start the process: www.cms.gov/nosurprises HHS help line: (800) 368-1019 ```