Protection against surprise billing
Your rights and protections
Surprise medical bills can cost you thousands of dollars depending on the procedure or service. The No Surprises Act protects you from these bills in certain situations.
When you receive medical care, your insurance company typically pays an agreed-upon portion of the charges (allowed amount). Your provider accepts that payment. Insurance companies may require you to pay a share of the allowed amount. These out-of-pocket costs may be in the form of copayments, coinsurance or deductibles.
Balance billing, also called surprise billing, occurs when a provider bills you for the difference between the charged amount and the allowed amount. Providers in your insurance plan’s network aren’t allowed to balance bill you. In certain circumstances, an out-of-network provider may send you a balance bill.
The No Surprises Act bans balance billing for:
Emergency services
If you receive emergency services from an out-of-network provider or facility, they can only charge your plan's in-network cost-sharing amount (copayments, coinsurance and deductibles). This includes services you receive after you're in stable condition, unless you give written consent to waive your balance billing protections.
In general, your insurance company must also cover emergency services without requiring you to get approval for services in advance (prior authorization).
Georgia patients: If you receive emergency medical services from an out-of-network provider or facility in Georgia, state law may also protect you from surprise billing.
Out-of-network providers at in-network facilities
When you go to an in-network hospital or ambulatory surgical center, you may unknowingly receive care from out-of-network providers. In this case, the most those providers can bill you is your plan's in-network cost-sharing amount. These providers cannot ask you to give up your balance billing protections, unless you voluntarily choose an out-of-network provider.
Georgia patients: When you receive out-of-network services from an in-network hospital or ambulatory surgical center in Georgia, state law may also protect you from surprise billing.
How to file a complaint
If you think you've been wrongly billed and would like to follow a complaint, call the U.S. Department of Health & Human Services at 800-985-3059.
For more information about your rights under Georgia law, contact the Office of Commissioner of Insurance and Safety Fire (OCI) at 404-656-2070 or 800-656-2298.
Read Atrium Health’s policy regarding your rights and protections against surprise billing: