Your Rights and Protections Against Surprise Medical Bills
When you receive emergency care or treatment from an out-of-network provider at an in-network hospital, you are protected from “surprise billing/balance billing.”
What is “balance billing” (sometimes called “surprise billing”)?
“Surprise billing” is an unexpected balance bill. This can happen when you can’t 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.
You are protected from balance billing for:
If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most that 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 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 to not be balanced billed for these post-stabilization services.
When you get services from an in-network hospital, some of the providers may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount.
Nearly all physicians at UAB Medicine facilities are in the same network as the hospital. In the rare case that a provider is not in the hospital network, UAB will limit your physician bill to your in-network cost-sharing amount.
You 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:
- You are only responsible for paying your share of the cost (like the 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.
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’ve been billed incorrectly, or for more information about your rights under federal law, please visit CMS.gov/nosurprises.