Consolidated Appropriations Act

Your rights and protections against surprise medical bills

Per federal law, you are protected from balance billing or surprise billing when you receive emergency care, air ambulance services, or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center.

Balance and surprise billing

Balance billing is when out-of-network providers (those who haven’t signed a contract with your health plan directly) bill you for the difference between what your plan agrees to pay and the full billed amount for a service. This balance owed may not count towards your plan out-of-pocket maximum.

Surprise billing is an unexpected balance bill. This can happen when you can’t control who is involved in your care, such as in an emergency or when an out-of-network provider treats you at an in-network facility.

You are protected from balance billing for:

Emergency and air ambulance services: An emergency service provider or facility can only bill you for your in-network cost sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency 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.  Out-of-network emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services providers at these in-network facilities can only bill you for your in-network cost sharing amount.  These providers cannot balance bill you and may not ask you to give up your protections not to be balance billed.  For other services provided 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 are 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 is not allowed, you are only responsible for in-network cost sharing. For more information on your covered services and protections, please review your member benefit documents.

Your health plan generally must:

  • Cover emergency services with out-of-network providers and without requiring you to get approval for services in advance.
  • Base your cost-sharing for emergency services, air ambulance services, or certain non-emergency services with an out-of-network provider at certain in-network facilities 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 plan deductible and out-of-pocket maximum.

Connecticut

For more information about your rights under federal and, if applicable, state  law or if you feel that a provider or facility has wrongly billed you, you may contact:

Massachusetts

Additionally, under Massachusetts law, a provider that is licensed in Massachusetts must also disclose their participation in your health plan and expected charges to you upon scheduling your non-emergency service or procedure.  You may also request this information from your provider. If your provider fails to provide you with these required notifications, they are not permitted to bill you more than your applicable cost share and you may not be subject to balance billing. Form more information, please visit the mass.gov website.

For more information about your rights under federal and, if applicable, state  law or if you feel that a provider or facility has wrongly billed you, you may contact:

Maine

For more information about your rights under federal and, if applicable, state  law or if you feel that a provider or facility has wrongly billed you, you may contact:

New Hampshire

For more information about your rights under federal and, if applicable, state  law or if you feel that a provider or facility has wrongly billed you, you may contact: