Surprise billing protections

You are protected from surprise bills

Under the federal No Surprises Act, you are protected from balance billing for emergency services and certain non-emergency services from out-of-network providers at in-network hospitals or facilities.

What is balance billing, or surprise billing?

Balance billing is when an out-of-network provider bills you for the difference between what your plan pays for a service and the full cost of a service. This amount is likely more than in-network costs for the same service and might not count toward your out-of-pocket maximum.

Surprise billing is an unexpected balance bill. You may get one of these when you’re in an emergency and can’t choose a provider for your care or when you visit an in-network facility but are unexpectedly treated by an out-of-network provider.

Which services cannot be balance billed?

The No Surprises Act protects you from being balance billed in these situations:

Emergency Services

Out-of-network providers and facilities cannot balance bill you for covered services for a medical emergency, including air ambulance services. The most you can be charged for is in-network cost-share amounts, such as your copay, coinsurance or deductible.

Certain services at an in-network hospital or ambulatory surgical center

Out-of-network providers who work at in-network hospitals or ambulatory surgical centers cannot balance bill you for covered services. The most you can be charged for is your in-network cost-share unless you give written consent.

Additionally, these providers cannot ask you to give up your balance billing protections through written consent:

• Emergency medicine
• Anesthesia
• Pathology
• Radiology
• Laboratory
• Neonatology
• Assistant surgeon
• Hospitalist or intensivist services

How will I be protected from balance billing?

You only have to pay your in-network cost-share, such as your copay, coinsurance and/or deductible. Any amount you pay for No Surprises Act-protected services count toward your in-network deductible and out-of-pocket maximum.

Your plan will pay out-of-network providers and facilities directly and send you an Explanation of Benefits (EOB) statement that clearly outlines your financial responsibility. Your plan will also cover emergency services without requiring you or your provider to get prior authorization.

Does this law apply to everyone, regardless of which health plan they have?

The No Surprises Act applies to these plans:

• Individual or group health insurance
• Self-funded plans
• Church plans
• Grandfathered plans
• Grandmothered plans
• Federal employee plans (FEP)

This law does not apply to these plans:

• Health reimbursement arrangements
• Short-term, limited-duration insurance
• Retiree-only plans
• Medicare Advantage plans
• Medicaid plans

Please note, plans such as Medicare and Medicaid and other public programs already generally prohibit balance billing.

What do I do if I think I’ve received a surprise medical bill?

If you have questions about your bill or believe you’ve been wrongly billed, you can call the Blue Cross of Idaho Customer Service Department at the number on the back of your member ID card. 

You can also contact Idaho Department of Insurance by visiting the department’s website at doi.idaho.gov/nosurprises or calling the Consumer Affairs section at 1-208-334-4319 or toll-free in Idaho at 1-800-721-3272. 

Where can I get more information on this?

Visit doi.idaho.gov/nosurprises for more information about your rights and protections under the No Surprises Act. You can also visit cms.gov/nosurprises for more information.

 

Posted: February 11, 2022