你r Rights and Protections Against Surprise Medical Bills
When you get emergency care or treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
What is “平衡账单” (sometimes called “surprise 计费”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. 你 may have other 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.
“Out-of-network” describes 供应商 and facilities that haven’t signed a contract with your health plan. 网外供应商可能 be permitted to bill you for the difference between what your plan agreed to pay and the full 量 charged for a service. 这叫做 “平衡账单”. This 量 is likely more than in-network costs for the same service and might 不 count toward your annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. 这可以 happen when you 不能 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.
你 are protected from balance billing for:
紧急服务
If you have an emergency medical condition and get emergency 服务 from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing 量 (such 作为共同支付和共同保险). 你 不能 be balance billed for these emergency 服务. 这包括服务 you may get after you’re in stable condition, unless you give written consent and give up your protections 不 to be balanced billed for these post-stabilization服务.
Refer to La RS 22:1880 (C) for details about the balance billing disclosure.
Certain 服务 at an in-network hospital or ambulatory surgical center
When you get 服务 from an in-network hospital or ambulatory surgical center, certain 供应商 there may be out-of-network. 在这些情况下， the most 供应商 may bill you is your plan’s in-network cost-sharing 量. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist 服务. 这些提供者 不能 平衡你和我的账单 不 ask you to give up your protections 不 to be balance billed.
If you get other 服务 at these in-network facilities, out-of-network 供应商 不能 balance bill you, unless you give written consent and give up your protections.
你 从来在线体育投注 required to give up your protections from balance billing. 你也不是 需要在网络外就医. 您可以选择供应商或设施 在你的计划网络中.
Refer to La RS 22:1880 (C) for details about the balance billing disclosure.
When balance billing isn’t allowed, you also have the following protections:
- 你 are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility 网内). 你r health plan will pay out-of-network 供应商 and 设施直接.
- 您的健康计划通常必须：
- Cover emergency 服务 without requiring you to get approval for 服务 提前（事先授权）.
- Cover emergency 服务 by out-of-network 供应商.
- Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that 量 in your explanation 的好处.
- Count any 量 you pay for emergency 服务 or out-of-network 服务 toward your deductible and out-of-pocket limit.
If you believe you’ve been wrongfully billed, you may contact the Louisiana Department of Insurance at (800) 259-5300. 访问 www.cms.政府 / nosurprises for more information about your rights under federal law. 访问 www.ldi.la.政府 for more information about your rights under state law.