No Surprises Act

Public Health Service Act 2799B-3 Protections Against Surprise Billing

The Public Health Service Act, amended in 2021 with an effective date of January 1, 2022 requires health care providers and facilities to post a notice of the following:

You are protected from balance billing for:

Emergency services – If you have an emergency medical condition and receive 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 coinsurance). You can’t be balance billed for emergency services. This includes services you may receive 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 receive services from an in-network hospital or ambulatory surgical center, certain providers may be out-of-network. In these cases, the most those providers can bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers cannot balance bill you or ask you to give up protections not to be balance billed.

If you receive 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. You also aren’t required to get care out-of- network. You can choose a provider or facility in your plan’s network.

When balance billing isn’t allowed, you also have the following protections:

Your health plan generally must:

Cover emergency services without requiring you to get approval for services in advance (prior authorization).
Cover emergency services by out-of-network providers.
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.

No Surprises Help Desk

1-800-985-3059
www.cms.gov/nosurprises/consumers
Texas Department of Insurance Help Line at 800-252-3439

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