You’re protected from surprise bills when you receive:
- Out-of-network emergency services, including air ambulance (but not ground ambulance)
- Out-of-network non-emergency, ancillary services* provided at in-network facility
- Non-emergency, non-ancillary services provided at in-network facility, and the provider did not get your prior consent in the way the No Surprises act requires.
And, for the above services, your health plan must ensure your cost-share (in other words, your coinsurance, copay, deductible):
- Be the same as it would have been if the service was provided in-network.
- Be based on what your plan would pay an in-network provider.
- Count toward your in-network deductible.
- Count toward your out-of-pocket maximum.
*Ancillary services include services related to emergency medicine, anesthesiology, pathology, radiology and neonatology; certain diagnostic services (including radiology and laboratory services); items and services provided by other specialty practitioners; and items and services provided by an out-of-network provider if there is no in-network provider that can provide that service.
Remember: Out-of-network providers may not ask you to give up your protections against surprise billing, and you are never required to do so.