Balance/Surprise Billing occurs when out of network providers bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This bill is likely more costly than the same services in-network and may not count toward your maximum out-of-pocket.
Your Rights and Protections against Surprise/Balance Billing
You can not be balance billed for an emergency service. The provider or facility is limited to billing your in-network cost-sharing amount (co-insurance/co-payments).
Services provided at an in-network ambulatory surgery center or hospital
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
These providers cannot balance bill you unless you provide written consent forfeiting your protections.
You are never required to give up your protections from balance billing.
The above information does not have the force of law and does not bind the public in any way. The purpose of the supplied information is solely to educate consumers regarding existing protections. If you believe you have been wrongly billed, please contact our customer care team:
Member Services: 713-270-1111
You may also submit a complaint online at https://www.cms.gov/nosurprises/consumers/complaints-about-medical-billing.