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你对意外医疗账单的权利和保护

When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, 您可以避免意外账单或余额账单.

请看更新后的 关于保护患者免受意外计费的通知.

什么是“余额账单”(有时称为“意外账单”)?

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. You may have other costs or have to pay the entire bill if you see a provider or visit a healthcare facility that isn't in your health plan's network.

“网络外”描述的是没有与您的健康计划签订合同的供应商和机构. 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. 这被称为“余额结算”." This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.

“意外账单”是指意外的余额账单. This can 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.

您将免受以下方面的结余计费保护:

紧急服务
如果您有紧急医疗状况，并从网络外的提供者或设施获得紧急服务, 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). 你不能为这些紧急服务结清帐单. This includes services you may get after you're in stable condition unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

网络内医院或流动外科中心的某些服务
当你从网络内医院或流动外科中心获得服务时, 某些提供商可能不在网络中. 在这些情况下，这些供应商可能向你收取的最多费用是你的计划的网络内费用分摊额. 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. 这些供应商不能平衡你的账单，可能不会要求你放弃你的保护不平衡账单.

如果您在这些网络内设施获得其他服务，网络外提供商 不能 余额账单，除非你书面同意并放弃保护.

你 从来没有 要求你放弃对余额账单的保护. 您也不需要获得网络外的护理. 您可以在您的计划网络中选择供应商或机构.

当不允许余额结算时，您还有以下保护:

  • 你只负责支付你的那部分费用(如共同支付), 共同保险, 如果医疗服务提供者或医疗机构在网络内，你需要支付的免赔额). 您的健康计划将直接支付网络外的供应商和设施.
  • 您的健康计划通常必须:
    • 承保紧急服务，无需事先获得服务批准(事先授权).
    • 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.

如果你认为你被冤枉了, you may contact the “No Surprises Helpdesk” at 1-800-985-3059 or the Nebraska Department of Insurance at 1-877-564-7323.

访问 http://www.cms.gov/nosurprises 了解更多有关您在联邦法律下的权利