Skip to main content

COVID-19 Hotline: 812.801.8010 | Monday - Friday 8A-5P

Rights Against Surprise Billing

Effective January 1, 2022
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.

What is “balance billing” ?

This is sometimes called "surprise billing."
When 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’t in your health plan’s network.

“Out-of-network” describes providers and facilities that haven’t 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 “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.

“Surprise billing” is an unexpected balance bill. This can happen when you can’t 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.

You are protected from balance billing for:

Emergency services
If 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 your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. 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.

Certain services at an in-network hospital or ambulatory surgical center
When you get 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 your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.

If you get other services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.

Your protections
You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network. For more information about your rights under federal law please visit the Centers for Medicare & Medicaid Services at
www.cms.gov/glossary/balance-billing-surpirise-bills
If you believe you’ve been wrongly billed, please contact our Customer Service at 812-801-0161

Your Rights to a Good Faith Estimate

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

If you are uninsured or don’t intend using insurance to pay for scheduled non-emergency health care services, federal law requires that health care providers and facilities provide you with an estimate of the expected charges for medical items and services at least 1 business day before the scheduled services are to be performed. If the bill you receive is at least $400 more than your Good Faith Estimate, you can dispute the bill.

Any patient may request an estimate of the expected charges for non-emergency health care services that have been ordered, scheduled or referred and state law requires that health care providers and facilities provide you with an estimate of the expected bill for medical items and services within 5 business days of the request.

When obtaining an estimate, make sure to save a copy or take a picture of your Good Faith Estimate.
Contact our Customer Service at 812-801-0161 to request a good faith estimate.

For more information about your right to a Good Faith Estimate, visit Centers for Medicare & Medicaid Services (CMS) at:
www.cms.gov/nosurprises/consumers or call 1-800-985-3059.

Subscribe to This Week in Health to get the latest health news delivered to your inbox.