Beginning January 2022, consumers with health coverage through their employer, Health Insurance Marketplace, or an individual health insurance plan purchased directly from an insurance company are protected from surprise billing. These rules:
- Ban surprise bills for emergency services, even if you get them out-of-network and without approval beforehand (prior authorization).
- Ban out-of-network cost-sharing (like out-of-network coinsurance or copayments) for all emergency and some non-emergency services. You can’t be charged more than in-network cost-sharing for these services.
- Ban out-of-network charges and balance bills for supplemental care (like anesthesiology or radiology) by out-of-network providers who work at an in-network facility.
- Require that health care providers and facilities give you an easy-to-understand notice explaining that getting care out-of-network could be more expensive and options to avoid balance bills. You’re not required to sign this notice or get care out-of-network.
If you don’t have insurance or choose to pay for care without using your insurance (also known as “self-paying” for care), these new rules make sure you can get a “good faith estimate” of how much your health care will cost before you get it, and might help them if you get a bill that’s larger than expected.
Some health insurance coverage programs already have protections against high medical bills. You’re already protected against surprise medical billing if you have coverage through Medicare, Medicaid, Indian Health Services, Veterans Affairs Health Care, or TRICARE.
If you believe you have been wrongly billed, you may contact District Medical Group (DMG) via email at email@example.com or by calling 602-470-5075.
Visit www.cms.gov/nosurprises/consumers or call the Help Desk at 1-800-985-3059 for more information. TTY users can call 1-800-985-3059 for more information about your rights.