State and federal law protects you from surprise or balance billing if you receive emergency care, including emergency behavioral health services at a medical facility or when you're treated at an in-network hospital or outpatient surgical facility by an out-of-network provider.
You’re also protected if you receive emergency behavioral health services from a:
Surprise billing happens because some types of medical providers and or facilities may not be contracted with your health insurer even though they provide services at a hospital or facility that is in your health plan’s provider network. You may also be taken to a hospital that is not in your health plan’s provider network in an emergency situation. So, in addition to your expected out-of-pocket costs, you might also get a bill for the difference between what your insurer has agreed to pay that provider and the amount the provider billed for their services.
Recent state and federal laws prevent people from getting a surprise medical bill when they receive emergency care from a hospital or certain behavioral health treatment facilities or if they have a scheduled procedure an in-network facility and receive care from an out-of-network provider. In this case, if an insurer and provider cannot agree on a price for the covered services, they must go to arbitration and cannot bill the consumer for the disputed amount.
If you get a surprise bill, contact the provider or facility and tell them you believe you've been wrongly billed. You can also file a complaint with our office and we will investigate on your behalf.
Surprise billing protections apply to all state-regulated health plans, state and school employee benefit plans and self-funded group health plans. Some self-funded group health plans provide greater protections to their members under our state law. These plans have notified us that they want to offer these additional protections to their enrollees.
See a current list of self-funded group health plans that have selected to follow the state surprise billing law.
If you receive a surprise medical bill, you're not responsible for paying it. Your insurer must pay the out-of-network provider and facility directly. You are only responsible for your in-network cost-sharing, including any copays, coinsurance and deductible.