防止意外医疗费用

When you see a doctor or other healthcare provider, 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.

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. 这就是所谓的余额结算. This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.

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.

有医疗保险的患者[1] are protected from balance/surprise billing for emergency services and certain services at an in-network hospital or ambulatory surgical center.

• 应急服务: 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 cannot 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.

• In-network Hospital or Ambulatory Surgical Center: When you get services from an in-network hospital or ambulatory surgical center, 某些提供商可能不在网络中. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. 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. These providers cannot 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 cannot balance bill you, unless you give written consent and give up your protections.

You’re never required to give up your protection 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.

当余额账单是不允许的, you are only responsible for paying your share of the cost like the copayments, coinsurance and deductibles you would pay if the provider or facility was in-network. Your health plan will pay out-of-network providers and facilities directly.

您的健康计划通常必须:

• Cover emergency services without requiring you to get approval for services in advance (prior authorization);
• Cover emergency services by out-of-network providers;
• 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.

Good Faith Estimate for 病人 Without Health Insurance

作为一个没有医疗保险的病人, you have the right to receive a good faith estimate explaining how much your medical care will cost.

• 根据法律, healthcare providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
• 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.
• Make sure your health care provider gives you a good faith estimate in writing at least one business day before your medical service or item. 您也可以询问您的医疗保健提供者, 以及您选择的任何其他提供商, for a good faith estimate before you schedule an item or service.
• If you receive a bill that is at least $400 more than your good faith estimate, 你可以对账单提出异议.
• Make sure to save a copy or picture of your good faith estimate.