Stay informed. On January 1, 2022, a new federal law, the “No Surprises Act” (NSA), will take effect. The No Surprises Act protects consumers against surprise medical bills. To learn more about the No Surprises Act visit www.cms.gov/nosurprises/consumers.
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.
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.
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.
If you think you’ve been wrongly billed, contact the Department of Managed Health Care at 1-888-466-2219 or the No Surprises Helpdesk at 1-800-985-3059 for information and complaints.
You can file a complaint by visiting www.HealthHelp.ca.gov or for more information about your rights under federal law visit www.cms.gov/nosurprises/consumers.
Pursuant to 127410 of the Health and Safety Code below is the information on the Health Consumer Alliance, an organization that will help the patient understand the billing and payment process and a list of the hospital's shoppable services.
The Health Consumer Alliance (HCA) is an independent consumer assistance program that offers free assistance over-the-phone or in-person to help people who are struggling to get or maintain health coverage and resolve problems with their health plans. HCA is able to assist you with applying for coverage such as Medi-Cal, Hospital Presumptive Eligibility, private insurance, or Covered California. You may contact HCA by telephone at (888) 804-3536 or online at http://healthconsumer.org/index.php?d=partners.
Visit the hospital’s list of Shoppable Services.
The Health Consumer Alliance (HCA) is an independent consumer assistance program that offers free assistance over-the-phone or in-person to help people who are struggling to get or maintain health coverage and resolve problems with their health plans. HCA is able to assist you with applying for coverage such as Medi-Cal, Hospital Presumptive Eligibility, private insurance, or Covered California. You may contact HCA by telephone at (888) 804-3536 or online.
Department of Managed Health Care (DMHC) educates consumers about their health care rights, resolves consumer complaints against health plans, helps consumers understand their coverage and assists consumers in getting timely access to appropriate health care services. The DMHC Help Center provides direct assistance in all languages to health care consumers through the Department’s website, www.HealthHelp.ca.gov, and a toll-free phone number, 1-888-466-2219.
To learn more about No Surprise billing protections for consumers contact 1-800-985-3059 or visit www.cms.gov/nosurprises/consumers
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