This mainly affects patients who are uninsured or are receiving services out-of-network. “Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan.
When you see a healthcare provider you may owe certain out-of-pocket costs, which can include copayments, coinsurance, and/or a deductible. If you see a healthcare provider or visit a healthcare facility that is not in your insurance plans network, you may have other costs or will need to pay the entire bill.
“Balance billing” can occur when an out-of-network provider bills you for the difference between what your plan agreed to pay and the full amount charges for services.
“Surprise billing” is an unexpected balance bill that can occur when you can’t control who is involved in your care. For example, in an emergency situation a provider that is not in your provider or the facility is not in network with your insurance plan.
Visit https://www.cms.gov/nosurprises/consumers for enforcement issues related to federally regulated plans.
Visit https://www.cms.gov/nosurprises for more information about you rights under federal law.
Visit https://www.dmhc.ca.gov/?referral=healthhelp.ca.gov for more information about your rights under state law.