{"id":1126,"date":"2025-09-25T10:13:43","date_gmt":"2025-09-25T10:13:43","guid":{"rendered":"https:\/\/mrarif.me\/primacares\/?page_id=1126"},"modified":"2025-09-25T10:29:15","modified_gmt":"2025-09-25T10:29:15","slug":"medical-bills","status":"publish","type":"page","link":"https:\/\/mrarif.me\/primacares\/medical-bills\/","title":{"rendered":"Medical Bills"},"content":{"rendered":"\t\t
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Medical Bills<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t
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Protections Against Surprise Billing<\/h2>\t\t\t\t<\/div>\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\tWhen you get emergency care or are 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.\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t
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What is \u201cbalance billing\u201d (sometimes called \u201csurprise billing\u201d)?<\/h5>\t\t\t\t<\/div>\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\tWhen 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. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn\u2019t in your health plan\u2019s network.\n\n\u201cOut-of-network\u201d describes providers and facilities that haven\u2019t 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. This is called \u201cbalance billing.\u201d This amount is likely more costly than in-network billing for the same service and might not count toward your annual out-of-pocket limit.\n\n\u201cSurprise billing\u201d is an unexpected balance bill. This can happen when you can\u2019t control who is involved in your care\u2014like when you have an emergency or when you schedule a visit to an in-network facility but are unexpectedly treated by an out-of-network provider.\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t
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You are protected from balance billing for<\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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Emergency services<\/h6>\t\t\t\t<\/div>\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\tIf 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 for your plan\u2019s in-network, cost-sharing amount (such as copayments and coinsurance). You cannot be balance billed for these emergency services. This includes services you may get after you\u2019re in stable condition unless you consent in writing to give up your protections not to be balance billed for these post-stabilization services.\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t
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Certain services at an in-network hospital or ambulatory surgical center<\/h6>\t\t\t\t<\/div>\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\tWhen you receive services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is for your plan\u2019s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers cannot balance bill you and may not ask you to give up your protections against balance billing.\n\nIf you get other services at these in-network facilities, out-of-network providers cannot balance bill you, unless you provide written consent to forfeit your protections.\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t
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Important to know<\/h6>\t\t\t\t<\/div>\n\t\t\t\t
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  • You\u2019re never required to give up your protections against balance billing.<\/li>\n \t
  • You also aren\u2019t required to choose care that is out-of-network. You can always choose a provider or facility in your plan\u2019s network.<\/li>\n<\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t
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    When balance billing isn\u2019t allowed, you also have the following protections:<\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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      \n \t
    • ou 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 was in-network). Your health plan will pay out-of-network providers and facilities directly.<\/li>\n \t
    • Your health plan generally must:<\/li>\n \t
    • Cover emergency services without requiring you to get prior authorization.<\/li>\n \t
    • Cover emergency services by out-of-network providers.<\/li>\n \t
    • 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.<\/li>\n \t
    • Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.<\/li>\n<\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t
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      If you believe you\u2019ve been wrongly billed, you may contact The Centers for Medicare and Medicaid Services at 1-800-985-3059.<\/p>

      Visit www.cms.gov\/nosurprises\/consumers for more information about your rights under federal law.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"

      Medical Bills Protections Against Surprise Billing When you get emergency care or are treated by an out-of-network provider at an […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"site-sidebar-layout":"no-sidebar","site-content-layout":"","ast-site-content-layout":"full-width-container","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"disabled","site-post-title":"","ast-breadcrumbs-content":"disabled","ast-featured-img":"disabled","footer-sml-layout":"","theme-transparent-header-meta":"default","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"set","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"class_list":["post-1126","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/mrarif.me\/primacares\/wp-json\/wp\/v2\/pages\/1126","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/mrarif.me\/primacares\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/mrarif.me\/primacares\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/mrarif.me\/primacares\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/mrarif.me\/primacares\/wp-json\/wp\/v2\/comments?post=1126"}],"version-history":[{"count":13,"href":"https:\/\/mrarif.me\/primacares\/wp-json\/wp\/v2\/pages\/1126\/revisions"}],"predecessor-version":[{"id":1183,"href":"https:\/\/mrarif.me\/primacares\/wp-json\/wp\/v2\/pages\/1126\/revisions\/1183"}],"wp:attachment":[{"href":"https:\/\/mrarif.me\/primacares\/wp-json\/wp\/v2\/media?parent=1126"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}