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意外计费保护

意外计费保护

你r Rights and Protections Against Surprise Medical Bills

When you receive emergency care or get treated by a provider that does 不 have an agreement with the Funds, you are protected from balance billing, 也被称为惊喜账单.  在这些情况下, you should 不 be charged more than your plan’s copayments, 共同保险和/或免赔额.

What is “balance billing” (sometimes called “surprise billing”)?

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, 比如共同支付, 共同保险, 和/或免赔额.  Sometimes providers will attempt to bill you for a doctor’s or other health care provider’s charges after the Funds makes payment.  这就是所谓的“余额结算”.”  的资金 encourages beneficiaries to see providers that have agreed to accept the Funds’ payment levels and will 不 bill you for the balance.  These cooperating providers are only permitted to bill you for copayments, 免赔额, 不包括在内的服务.

Providers who have 不 signed an agreement with the Funds may be referred to as “non-cooperating providers.”  If a non-cooperating provider attempts to bill you for the difference between what the Funds paid on a claim and the full amount charged for a service, the Funds’ 保持无害程序 protects you from paying the balance.  Now you also have protections under the 没有惊喜 Act for certain services.

惊喜计费” is an unexpected balance bill that is sent to you after the Funds’ has paid the claim.  Sometimes this happens when you have an emergency or when you schedule a visit at a facility that has an agreement with the Funds but are unexpectedly treated by a non-cooperating provider and are billed for the balance after the Funds’ payment.  例如:

  • 紧急服务

If you have an emergency medical condition and get emergency services from a Funds’ non-cooperating provider or facility, the most they can bill you is your Funds’ cost-sharing amount (such as copayments 和免赔额s).  你 不能 be balance billed 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 不 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 a Funds’ cooperating provider that is a hospital or an ambulatory surgical center, the most those providers may bill you is your copayment, 共同保险, 和免赔额. 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. 这些提供者 不能 平衡你和我的账单 ask you to give up your protections 不 to be balance billed.  If you get other services at these cooperating providers, non-cooperating providers 不能 balance bill you, unless you give written consent and give up your protections.

Please remember that you are never required to give up your protections from balance billing.  你 can choose any provider for treatment, but the Funds encourages you to use a Funds’ cooperating provider.

通知及同意表格

When services you will receive will be provided by a non-cooperating provider, you may be asked to sign a consent form that would allow them to bill you for the balance after the Funds’ payment.  你 are 不 required to sign these forms.

  • 如果你签了同意书, you are agreeing to give up payment protections and you will likely have to pay more than if you were treated by a Funds’ cooperating provider.
  • 如果你不签同意书 a provider or facility may refuse to provide certain treatment.
  • 你可以在这里查看表格 xxjspv.agencedigitalt.com.

When balance billing is 不 allowed, you also have the following protections:

  • 你 are only responsible for paying your share of the cost (copayments, 共同保险, 和免赔额) that you would pay if the provider or facility was a Funds’ cooperating provider.
  • 您的健康计划通常必须:
    • Cover emergency services without requiring you to get approval for services in advance (also known as “prior authorization”).
    • Cover emergency services provided by non-cooperating providers.
    • Base what you owe the provider or facility (cost-sharing) on what it would pay a Funds’ cooperating provider or facility and show that amount in your explanation of
    • Count any amount you pay for emergency services or services received at non-cooperating providers toward your deductible and out-of-pocket

 

If you believe you’ve been wrongly billed, you may contact the Funds’ Call Center at 1-800-291-1425.   The federal phone number for information and complaints is: 1-800-985-3059.

 

访问 http://www.cms.gov/nosurprises/consumers for more information about your rights under federal law.