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 surprise billing or balance billing.

What is “平衡账单” (sometimes called “surprise billing”)?

当你去看医生或其他医疗保健提供者时, 你可能需要支付一些自付费用, 比如共同支付, 共同保险, 和/或免赔额. 你 may have other costs or have to pay the entire bill if you see a provider 或访问 a health care facility that isn’t in your health plan’s network.

“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. 这叫做 “平衡账单.” This amount is likely more than in-network costs for the same service and might 不 count toward your annual out-of-pocket limit.

您将免受以下方面的结余计费保护:

紧急服务

If you have an emergency medical condition and get emergency services 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 amount (such as copayments and 共同保险). 你 不能 这些紧急服务的帐单已结余. This includes services 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 services.

另外, Colorado protects patients covered by managed care plans from surprise medical bills for health care services provided at an in-network facility by an out-of-network provider. Colorado also protects patients from surprise medical bills for emergency services, even if the emergency services are out of network or provided by an out-of-network provider. Colorado law requires that patients pay only their in-network cost sharing amounts.
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Colorado law offers additional protections and requires that patients pay only their in-network cost sharing amounts.

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

When you get services from an in-network hospital or ambulatory surgical center, 某些提供商可能不在网络中. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. 这适用于急诊医学, 麻醉, 病理。, 放射学, 实验室, 新生儿学, 助理外科医生, hospitalist, 或者重症监护服务. 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.

如果您在这些网络内设施获得其他服务, out-of-network providers 不能 balance bill unless you give written consent and give up your protections.

你 从来没有 要求你放弃对结余账单的保护. 您也不需要获得网络外的护理. 你 can choose a provider or facility in your plan’s network.

Colorado law does 不 protect patients from surprise medical bills when the patient intentionally uses an out-of-network provider.

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, 共同保险, and deductibles that you would pay if the provider or facility was in-network). 你r health plan will pay out-of-network providers and facilities directly.
• 您的健康计划通常必须:
  • Cover emergency services without requiring you to get approval for services in advance (prior authorization).
  • 覆盖网络外供应商提供的紧急服务.
  • Base what you owe the provider or facility (cost-sharing) on what it would pay an   in-network provider or facility and show that amount in your explanation of benefits.
  • Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

If you believe you’ve been wrongly billed, you may contact:

• CMS的医疗保险和医疗补助服务中心 http://www.cms.gov/ nosurprises /消费者 你在联邦法律下的权利.
• Patients with Colorado-based health plans may also contact the Colorado State Division of Insurance at 303-894-7490 or 1-800-9303745 或访问 http://doi.colorado.gov/消费者/投诉

访问 http://www.cms.gov/files/document/model-disclosure-notice-patient-protections-against-surprise-billing-providers-facilities-health.pdf 以了解更多有关你在联邦法律下的权利.

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诚信估计披露

你 have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.

根据法律，医疗服务提供者需要给予 patients who don’t have insurance or who are 不 using insurance 医疗项目和服务费用的估计.

• 你 have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
• Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item.
• If you receive a bill that is at least $400 more than your Good Faith Estimate, 你可以对账单提出异议.
• Make sure to save a copy or picture of your Good Faith Estimate.

For question or more information about your right to a Good Faith Estimate, 请与您的卫生保健区服务提供者联系, 或访问 www.cms.gov /nosurprises.