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No Surprise Billing

Your Rights and Protections Against Surprise Medical Bills

    When you receive treatment by an out-of-network provider at an in-network medical facility, like MCHC, you are protected from surprise billing or balance billing.

What is "balance billing" or "surprise billing"?

    When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that is not in your health plan's network.

    "Out-of-network" describes providers and facilities which have not signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called "balance billing". This amount is likely more than in-network costs for the same service and might not count towards your annual out-of-pocket limit. "Surprise billing" is an unexpected balance bill. This can happen when you cannot control who is involved in your care--like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.

     When Balance billing is not allowed, you also have the following protections:

  •     You are only responsible for paying your share of the cost (like copayments, coinsurance and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.

  •     If you get other services in-network, out-of-network providers cannot balance bill you, unless you give written consent and give up your protections.

YOU ARE NOT REQUIRED TO GIVE UP YOUR PROTECTIONS FROM BALANCE BILLING. YOU ALSO ARE NOT REQUIRED TO GET CARE OUT-OF-NETWORK. YOU CAN CHOOSE A PROVIDER OR FACILITY IN YOUR PLAN'S NETWORK

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.

IF YOU BELIEVE THAT YOU HAVE BEEN WRONGLY BILLED, you may contact the U.S. Department of Health and Human Services (HHS) or the Kentucky Cabinet for Health and Family Services.

Visit: https://www.kff.org/private-insurance/fact-sheet/surprise-medical-bills-new-protections-for-consumers-take-effect-in-2022/