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.
Health insurance plans typically cover a portion of medical bills that occur in-network (within a group of providers and facilities).
When you need out-of-network care unexpectedly, your insurance company may ask you to pay the difference between tin-network and out-of-network costs (called balance billing). This might not count toward your annual out-of-pocket limit. Balance billing has been called “surprised billing,” because you may receive a bill unexpectedly.
Laws are in place to protect you from being billed more for out-of-network services than your in-network cost sharing amount (copay, coinsurance, or deductible).
The most you can be billed for emergency services is your plan’s in-network cost sharing amount. This includes services you may get after you are in stable condition, unless you sign a written consent allowing us to balance bill you for those services.
You can only be billed your plans in-network cost sharing amount if you:
For services it listed above, your out-of-network provider must have your written consent to balance bill you. Signing the consent gives up your protection not to be balanced billed. The provider cannot ask you to give up this protection.
When balance billing is not allowed, you are only responsible for paying your share of the costs (such as copayments, coinsurance, or the deductible that you would pay if the provider or facility was in-network.)
Your health plan generally must:
You are never required to give up your protections from balance billing.
If you believe you have been wrongly billed, you may contact 1-800-985-3059.
Visit www.cms.gov/nosurprises/consumers for more information about your rights under federal law.
Visit www.ag.state.mn.us/consumer/health/default.asp for more information about your rights under Minnesota law.
You have the right to a written estimate of your medical bill (called a Good Faith Estimate) when:
You may also request an estimate if one is not automatically provided.
The Good Faith Estimate will include the expected charges of the item or service, such as: the cost of the non-emergent clinic visit, plus any tests, procedures, and supplies.
Make sure to save a copy or photo of your Good Faith Estimate. If you receive a bill from us that is at least $400 more than your estimate, you can dispute it. This must be done within 120 calendar days of receiving the bill.
Our patient account representatives can answer questions about your Good Faith Estimate and explain the possible costs of your care.
St. Paul Eye Clinic Business Office 651-738-6600
For more information about your rights and the No Surprise Bill Act, visit: