No Surprises Act
Your Rights and Protections Against Surprise Medical Bills
What is “balance billing” (sometimes called “surprise billing”)?
If you see a healthcare provider or healthcare facility that is not in your health plan’s network of providers and facilities (or “out-of-network”), they may bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is “balance billing.” This amount may be more than what you would have paid for the same service if you had seen an in-network provider or healthcare facility, and it may not count toward your annual out-of-pocket limit.
When instances prevent you from choosing who provides your care, such as during emergencies or when you are treated by an out-of-network provider at an in-network facility, you may receive an unexpected balance bill. This situation is “surprise billing.”
You are protected from balance billing for:
Emergency services: You cannot be balance billed for emergency services from an out-of-network provider or facility to treat an emergency medical condition. The most the provider or facility may bill you is the cost-sharing amount (such as copayments and coinsurance) that you would have paid at an in-network provider or facility. This includes services you may get after you are in a stable condition, unless you give written consent to be balance billed and give up your protections.
Certain non-emergency services at an in-network hospital or ambulatory surgical center provided by out-of-network provider:
For many non-emergency services at in network hospitals or ambulatory surgical centers, out-of-network providers cannot balance bill you, unless you give written consent and give up your protections. In the case of emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services, these providers can never balance bill you, and may not ask you to consent to give up your protections not to be balance billed. The most those providers may bill you is your plan’s in-network cost-sharing amount.
Illinois Law
In addition to protections under federal law, Illinois law may also protect you from balance billing. If you have a health plan overseen by the State of Illinois and you receive anesthesiology, emergency, laboratory, pathology, or radiology services provided by an outof-network provider at an in-network hospital or ambulatory surgical center, those providers cannot balance bill you under Illinois law.
You are never required to give up your protections from balance billing. You also are not required to get care out-of-network. You can choose a provider or facility in your plan’s network.
When balance billing is not allowed, you also have the following protections:
- You 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 were in-network). Your health plan will pay out-of-network providers and facilities directly.
- Your health plan generally must:
- Cover emergency services without requiring you to get approval for services in advance (prior authorization).
- Cover emergency services by out-of-network providers.
- Based on 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 have been wrongly billed, you may contact:
UChicago Medicine
1-844-843-3594
Ingalls Memorial and Northwest Indiana
708-333-1100
or
Federal No Surprises Helpdesk
1-800-985-3059
or
Illinois Department of Insurance
Office of Consumer Health Insurance
320 West Washington Street
Springfield, IL 62767
Toll-free: 877-527-9431
TDD: 866-323-5321
Fax: 217-558-2083
Visit www.cms.gov/nosurprises for more information about your rights under federal law.
Visit http://insurance.illinois.gov for more information about your rights under Illinois law.