Your Rights and Protections Against Surprise Medical Bills
Last updated March 2022
When you are treated by an out-of-network provider, it may cost you more than if you were treated by an in-network provider.
What is “balance billing”?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs like a copayment, coinsurance, or deductible. You may have additional 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.
“Out-of-network” means providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your plan’s deductible or annual out-of-pocket limit.
You’re protected from balance billing for:
● emergency services from an out-of-network provider or facility
● out-of-network providers at an in-network hospital or ambulatory surgical center
You’re NOT protected from balance billing for:
● choosing to see out-of-network providers in the outpatient setting
You have a right to a good faith estimate of expected charges for a scheduled requested service.
This will be provided upon request or after scheduling if we are out-of-network with your insurance.
You’re never required to give up your protections from balance billing. You also aren’t required to get out-of-network care. You can choose a provider or facility in your plan’s network.
If you think you’ve been wrongly billed, contact Oregon’s Surprise Billing Department at 1-888-877-4849 or the Centers for Medicare and Medicaid Services at 1-800-985-3059. Your state website can be found at www.oregon.gov and by searching “no surprises, balance billing or consumer protections.”
Visit https://www.cms.gov/nosurprises for more information about your rights under federal law.
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Effective as of 03/11/2022