Federal Surprise Billing Notice
Your Rights and Protections Against Surprise Medical Bills
When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible.
Frequently asked questions about the No Surprises Act
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” means providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays 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 toward your plan’s deductible or annual out-of-pocket limit.
“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. Surprise medical bills could cost thousands of dollars depending on the procedure or service.
You’re protected from balance billing for:
Emergency services
If you have an emergency medical condition and get emergency services from an out-of- network provider or facility, the most they can bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). 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 not 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 an in-network hospital or ambulatory surgical center, certain providers there 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 can’t balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other types of 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 out-of-network care. You can choose a provider or facility in your plan’s network.
When balance billing isn’t allowed, you also have these protections:
- You’re only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.
- Generally, your health plan must:
- Cover emergency services without requiring you to get approval for services in advance (also known as “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 in-network deductible and out-of-pocket limit.
If you think you’ve been wrongly billed, contact the entity responsible for enforcing federal and/or state balance or surprise billing protection laws (see chart below) or you may call the federal phone number for information and complaints 1-800-985-3059.
Visit www.cms.gov/nosurprises/consumers for more information about your rights under federal law.
State |
Enforcement Entity |
|---|---|
Alaska |
Division of Insurance Consumer Services Section 550 West 7th Avenue, Suite 1560 Anchorage, AK 99501-3567 Telephone: (907) 269-7900 (800) INSURAK (800) 467-8725 (In-state only) |
American Samoa |
Office of the Insurance Commissioner Office of the Governor American Samoa Government A. P. Lutali Executive Office Building Pago Pago, American Samoa 96799 Telephone (684) 633-4116 |
Arizona |
Consumer Assistance Section To file a complaint, go to https://insurance.az.gov/complaint Street Address: 100 N. 15th Avenue, Suite 261 Phoenix AZ 85007-2630 Contact Hours: Monday - Friday, 9AM to 4PM Phone: 602-364-2499 In-state toll-free 800-325-2548 |
Arkansas |
Arkansas Insurance Department 1 Commerce Way, Suite 102 Little Rock, AR 72202 t: 800-852-5494 or 501-371-2640 Website: insurance.arkansas.gov |
California |
For products regulated by the California Department of Insurance: California Department of Insurance: Consumer Communications Bureau 300 South Spring Street, South Tower Los Angeles, CA 90013 Toll-Free Consumer Hotline: 1-800-927-HELP (4357) or 1-213-897-8921 TDD Number: 1-800-482-4TDD (4833) For products regulated by the California Department of Managed Health Care: California Consumer Assistance Program Operated by the California Department of Managed Health Care 980 9th St, Suite #500 Sacramento, CA 95814 (888) 466-2219 (TDD: 1-877-688-9891) |
Colorado |
Colorado Division of Insurance 1560 Broadway, Suite 850 Denver, CO 80202 Phone: 303-894-7490 or 1-800-930-3745 (toll free if calling from outside Denver metro area) Online complaint submissions: http://www.dora.state.co.us/pls/real/Ins_Complaint.Submit_Form |
Connecticut |
Office of the Healthcare Advocate P.O. Box 1543 Hartford, CT 06144 Telephone: 866-466-4446 Website: www.ct.gov/oha E-mail : healthcare.advocate@ct.gov |
Delaware |
Delaware Department of Insurance Consumer Services Division 1351 West North St, Suite 101 Dover, DE 19904 Toll-free telephone: 1-800-282-8611 Local telephone: (302) 674-7310 Website: https://insurance.delaware.gov/ E-mail: consumer@state.de.us |
District of Columbia |
Government of the District of Columbia Office of Healthcare Ombudsman and Bill of Rights 441 4th Street, NW Suite 250N Washington, DC 20001 Telephone: 202-724-7491 or Toll free: 1-877-685-6391 E-Mail: healthcare ombudsman@dc.gov Website: healthcareombudsman.dc.gov |
Florida |
There is no enforcement entity for the state of Florida. |
Georgia |
Georgia Office of Insurance and Safety Fire Commissioner Consumer Services Division 2 Martin Luther King, Jr. Drive West Tower, Suite 716 Atlanta, Georgia 30334 Toll-free telephone: 1-800-656-2298 |
Guam |
Guam Department of Revenue and Taxation 1240 Army Drive Barrigada, Guam 96913 Telephone: (671) 635-1844 |
Hawaii |
Insurance Division- Health Branch State of Hawaii P.O. Box 3614 Honolulu, HI 96811-3614 Phone: 808-586-2804 |
Idaho |
Idaho Department of Insurance Website: doi.idaho.gov/nosurprises Call Consumer Affairs at 1-208-334-4319 or toll-free in Idaho at 1-800-721-3272. |
Illinois |
Illinois Department of Insurance 320 W. Washington St Springfield, IL 62767 Phone: 217-782-4515 Toll-free telephone: 1-866-445-5364 Web site: http://insurance.illinois.gov/healthinsurance/consumerHealth.html Email: DOI.InfoDesk@illinois.gov |
Indiana |
Indiana Department of Insurance Consumer Services Department 311 W. Washington Street, Suite 300 Indianapolis, IN 46204-2787 Phone: (317) 232-2385 Fax: (317) 234-2103 Website for access to additional information and forms: http://in.gov/idoi/ |
Iowa |
Please call 1-800-985-3059. Iowa residents may contact the Iowa Insurance Division at 1-515-654-6600 or https://iid.iowa.gov/consumers/filing-complaints |
Kansas |
Kansas Insurance Department 1300 SW Arrowhead Rd Topeka, KS 66604 Toll-free telephone: 1-800-432-2484 (In Kansas only) (785)296-3071 (All others) Web site: http://www.ksinsurance.org E-mail: kid.commissioner@ks.gov |
Kentucky |
Kentucky Department of Insurance, Consumer Protection Division P.O. Box 517 Frankfort, KY 40602-0517 Toll-free telephone: 1-800-595-6053 Web site: http://insurance.ky.gov Email: consumerservices@ky.gov |
Louisiana |
Louisiana Department of Insurance 1702 N 3rd Street Baton Rouge, LA 70802 Web Site: http://www.ldi.state.la.us Phone: 800-259-5300 or 225-342-5900 |
Maine |
Consumers for Affordable Health Care 12 Church Street, PO Box 2490 Augusta, ME 04338-2490 |
Maryland |
Maryland Office of the Attorney General Health Education and Advocacy Unit 200 St. Paul Place, 16th Floor Baltimore, MD 21202 Toll-free telephone: 1-877-261-8807 Web site: https://www.marylandattorneygeneral.gov/Pages/CPD/HEAU/default.aspx E-mail: heau@oag.state.md.us |
Massachusetts |
Health Policy Commission Office of Patient Protection (OPP) 50 Milk Street, 8th Floor Boston, MA 02109 Toll-free telephone: (800) 436-7757 Website: http://www.mass.gov/hpc/opp Email: HPC-OPP@state.ma.us |
Michigan |
Michigan Department of Insurance and Financial Services HICAP PO Box 30220 Lansing, MI 48909-7720 Toll-free telephone: 1-877-999-6442 Web site: http://www.michigan.gov/HICAP E-mail: DIFS-HICAP@michigan.gov |
Minnesota |
For Insured plans: Minnesota Department of Commerce Insurance Division 85 7th Place East St. Paul, MN 55101 651-539-1600 or 1-800-657-3602 For HMOs: Minnesota Department of Health Attn: Managed Care Section P.O. Box 64882 St. Paul, MN 55164-0882 |
Missouri |
Missouri Department of Commerce and Insurance (DCI) Division of Consumer Affairs 301 W. High Street, Room 530 Harry S. Truman State Office Building Jefferson City, MO 65101 Toll-free telephone: 1-800-726-7390 Web site: www.insurance.mo.gov/consumers E-mail: consumeraffairs@insurance.mo.gov |
Mississippi |
Health Help Mississippi 800 North President Street Jackson, MS 39202 www.healthhelpms.org Consumer Help Line 1-877-314-3843 Email: info@mhap.org |
Montana |
Montana Commissioner of Securities and Insurance 840 Helena Avenue Helena, MT 59601 Phone: (800) 332-6148 or (406) 444-2040 TDD: (406) 444-3246 Web site: http://www.csi.mt.gov/ |
Nebraska |
Nebraska Department of Insurance PO Box 82089 Lincoln, NE 68501-2089 Phone: (402) 471-2201 Consumer Hotline: (877) 471-2201 Department's website is doi.nebraska.gov |
Nevada |
Office of the Governor, Consumer Health Assistance 3320 W. Sahara Ave., Suite 100 Las Vegas, NV 89102 Telephone: (702) 486-3587 Toll-free telephone: 1-888-333-1597 Web site: https://adsd.nv.gov/Programs/ADSD_Programs/ E-mail: cha@govcha.nv.gov |
New Hampshire |
New Hampshire Department of Insurance 21 South Fruit Street, Suite 14 Concord, NH 03301 TDD: (800) 735-2964 Fax: (603) 271-1406 Web site: www.nh.gov/insurance E-mail: consumerservices@ins.nh.gov |
New Jersey |
New Jersey Department of Banking and Insurance Consumer Assistance 20 West State Street PO Box 329 Trenton, NJ 08625-0329 Telephone: (609) 292-7272 E-mail: ombudsman@dobi.nj.gov Electronic complaint submissions: https://www.state.nj.us/dobi/consumer.htm |
New Mexico |
Mailing Address: New Mexico Office of Superintendent of Insurance Managed Health Care Bureau Post Office Box 1689 Santa Fe, New Mexico 87504-1689 Phone: 1-855-427-5674 (1-855-4 ASK OSI) Email: mhcb.grievance@state.nm.us Website: http://www.osi.state.nm.us/ManagedHealthCare/index.aspx |
New York |
New York State Department of Financial Services (800) 342-3736 or surprisemedicalbills@dfs.ny.gov. Website: http://www.dfs.ny.gov For self-funded coverage or coverage bought outside New York, contact CMS at 1-800-985-3059 |
North Carolina |
North Carolina Department of Insurance Health Insurance Smart NC Toll Free Telephone: (855) 408-1212 Website: https://www.ncdoi.gov/consumers/health-insurance/health-claim-denied By Mail: 1201 Mail Service Center Raleigh NC 27699-1201 |
North Dakota |
North Dakota Insurance Department State Capitol, Fifth Floor 600 E. Boulevard Ave Bismarck, ND 58505-0320 800-247-0560 toll free 800-366-6888 (TTY) |
Ohio |
The Ohio Department of Insurance 50 W. Town Street Third Floor – Suite 300 Columbus, OH 43215 Consumer Hotline: 1-800-686-1526 Website: http://www.insurance.ohio.gov |
Oklahoma |
Oklahoma Insurance Department 400 NE 50th Street Oklahoma City OK 73105 Toll-free telephone: 1-800-522-0071 (in-state only) Telephone: (405) 521-2828 Web site: https://www.oid.ok.gov/consumers/ |
Oregon |
Oregon Division of Financial Regulation P.O. Box 14480 Salem, OR 97309-0405 Telephone: 503-947-7984 or toll-free in Oregon at 888-877-4894 Email: DFR.InsuranceHelp@dcbs.oregon.gov Website: https://dfr.oregon.gov |
Pennsylvania |
Pennsylvania Insurance Department 1209 Strawberry Square Harrisburg, PA 17120 Phone: (877) 881-6388 TTY/TDD: (717) 783-3898 Website: www.insurance.pa.gov |
Puerto Rico |
Puerto Rico Oficina de la Procuradora del Paciente Mailing Address: PO Box 11247 San Juan Puerto Rico 00910-2347 Toll-free telephone: 1-800-981-0031 Local telephone: (787) 977-1100 Website: http://www.opp.pr.gov/ Email: querellas@opp.gobierno.pr |
Rhode Island |
Rhode Island Insurance Resource, Education, and Assistance Consumer Helpline Rhode Island Parent Information Network (RIPIN) 300 Jefferson Boulevard, Suite 300 Warwick, RI. 02888 Toll-Free Telephone: (855) 747-3224 (855-RIREACH) Telephone: (401) 270-0101 Web site: www.ripin.org E-mail: info@ripin.org |
South Carolina |
South Carolina Department of Insurance Consumer and Individual Licensing Services Division P.O. Box 100105 Columbia, SC 29202 Toll-free telephone: 1-800-768-3467 Web site: http://www.doi.sc.gov E-mail: consumers@doi.sc.gov |
South Dakota |
South Dakota Division of Insurance 445 East Capitol Avenue Pierre, SD 57501 Main Phone Line: 605-773-3563 Email: insurance@state.sd.us |
Tennessee |
Tennessee Department of Commerce and Insurance Consumer Insurance Services 500 James Robertson Pkwy Davy Crockett Tower, 4th floor Nashville, TN 37243 Telephone: 615-741-2218 or toll-free 1-800-342-4029 Email: Ask.TDCI@TN.Gov |
Texas |
Texas Health Options Toll-free telephone: 1-800-252-3439 Web site: www.texashealthoptions.com |
Utah |
Visit: https://www.cms.gov/nosurprises or, call 1-800-985-3059 |
Vermont |
Vermont Legal Aid 264 North Winooski Ave. Burlington, VT 05402 Toll-free telephone: (800) 889-2047 Web site: www.vtlegalaid.org |
Virginia |
Office of the Managed Care Ombudsman Bureau of Insurance P.O. Box 1157 Richmond, VA 23218 Toll-free telephone: 1-877-310-6560 Richmond: 804-371-9032 Website: http://www.scc.virginia.gov/boi/omb/index.aspx Email: ombudsman@scc.virginia.gov |
Virgin Islands |
Division of Banking and Insurance 1131 King Street, Suite 101 Christiansted, St. Croix, VI 00820 Phone: (340)773-6459 Website: http://ltg.gov.vi |
Washington |
Washington State Office of the Insurance Commissioner P.O. Box 40256 Olympia, WA 98504-0256 Phone: 1-800-562-6900 or (360) 725-7080 TDD: (360) 586-0241 Website: www.insurance.wa.gov Email: cap@oic.wa.gov |
West Virginia |
West Virginia Office of the Insurance Commissioner Consumer Service Division P.O. Box 50540 Charleston, WV 25305 Toll-free telephone: 1-888-879-9842 Website: http://www.wvinsurance.gov/ConsumerServices/ConsumerServices.aspx |
Wisconsin |
Office of the Commissioner of Insurance 125 South Webster Street P.O. Box 7873 Madison, WI 53707-7873 Phone: 800-236-8517 (Statewide) or 608-266-3586 (In Madison) Website: Website: http://oci.wi.gov/ E-mail: ocicomplaints@wisconsin.gov |
Wyoming |
Wyoming Insurance Department Consumer Affairs Section 106 East 6th Avenue Cheyenne, WY 82002 (307) 777-7402 In-state toll free: 1-800-438-5768 Online complaint submissions: https://doi.wyo.gov/consumers |
If you believe you’ve been wrongly billed, please call the federal No Surprises Help Desk at 1-800-985-3059. Visit www.cms.gov/nosurprises for more information about your rights under federal law.