You’re protected from balance billing for: Surprise medical bills could cost thousands of dollars depending on the procedure or service. 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 billing” is an unexpected balance bill. 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. 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. “Out-of-network” means providers and facilities that haven’t signed a contract with your health plan to provide services. 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. When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or a deductible. What is “balance billing” (sometimes called “surprise billing”)? When you get emergency care or get 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.
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