Your Rights and Protections Against Surprise Medical Bills and Transparency in Coverage
When you get emergency care or get treated by an out-of-network provider at an in-network hospital
or ambulatory surgical center for certain services, you are
protected from surprise billing or balance billing.
What is “balance billing” (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:
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.
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.
When balance billing isn’t allowed, you also have the following protections:
If you believe you’ve been wrongly billed, you may contact the United States Department of
Health and Human Services by calling the No Surprises Help Desk at 1-800-985-3059 or by
Visit www.cms.gov/nosurprises for more information about your rights under federal law.
- You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles
that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers
and facilities directly.
- Your health plan generally must:
- 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.
If you would like to request a paper copy of this notice, please contact the Plan Administrator at the following address:
TS Tech Plan Administrator, 8458 East Broad Street, Reynoldsburg, Ohio 43068-9749.
The contents of this document do not have the force and effect of law and are not meant to bind the public in any way,
unless specifically incorporated into a contract. This document is intended only to provide clarity to the public
regarding existing requirements under the law.
This notice is effective as of 1/1/2022.
Transparency in Coverage: