Balance Billing 

FILING A COMPLAINT:

You may file a complaint with the federal government through the U.S. Department of Health and Human Services at https://www.cms.gov/nosurprises/consumers or by calling 1-800-985-3059.

ADDITIONAL INFORMATION:

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

FILING A COMPLAINT:

A patient who receives a surprise bill can file an appeal with their insurance company or may ask for an external review of the company’s decision. You also can file a complaint with the Alaska Division of Insurance or the federal Department of Health and Human Services (HHS).

You can reach the Alaska Division of Insurance at 1-907-269-7900 or complete a complaint online at https://www.commerce.alaska.gov/web/ins/Consumers/Complaints.aspx. You can get more information about filing a complaint with the Alaska Division of Insurance by calling 1-907-269-7900. You may file a complaint with the federal government through the U.S. Department of Health and Human Services at https://www.cms.gov/nosurprises/consumers or by calling 1-800-985-3059.

STATE AGENCY CONTACT INFORMATION:

Alaska Division of Insurance

PHONE: 1-907-269-7900; insurance@alaska.gov

WEBSITE: https://www.commerce.alaska.gov/web/ins/Consumers/Complaints.aspx

ADDITIONAL INFORMATION:

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

FILING A COMPLAINT:

You can file a complaint with the federal government via the Consumer Web Form. Helpful tips on how to complete the complaint form can be found at https://www.cms.gov/medical-bill-rights.  You can also call the No Surprises Help Desk at 1-800-985-3059 *8am - 8pm EST, 7 days a week.

You may file a complaint with the federal government through the U.S. Department of Health and Human Services at https://www.cms.gov/nosurprises/consumers or by calling 1-800-985-3059.

STATE AGENCY CONTACT INFORMATION:

Arizona Department of Insurance & Financial Institutions

PHONE: 1-602-364-3100

WEBSITE: https://difi.az.gov/federal-no-surprises-act

ADDITIONAL INFORMATION:

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law. 

ADDITIONAL STATE-LAW PROTECTIONS FOR PATIENTS WITH STATE-REGULATED HEALTH PLANS:

Acts 578 and 597 of 2023 by the Arkansas General Assembly prohibit ground ambulance providers from balance billing insureds covered by a health benefit plan subject to state jurisdiction or otherwise demanding payment other than a deductible, copayment, or coinsurance required under the insured’s health benefit plan.

FILING A COMPLAINT:

If you have a complaint or questions, please contact the Consumer Services Division at 501-371-2640 or toll-free 1-800-852-5494. You may also contact via email insurance.consumers@arkansas.gov. If you would like to file a complaint, you may file through the Arkansas Insurance Department website https://insurance.arkansas.gov/pages/consumer-services/consumer-services/.

STATE AGENCY CONTACT INFORMATION:

Arkansas Insurance Department

PHONE: 1-501-371-2640

WEBSITE: https://insurance.arkansas.gov/pages/consumer-services/consumer-services

ADDITIONAL INFORMATION:

For additional information, consumers can call the AID Consumer Services Division toll free at 1-800-852-5494, or the No Surprises Help Desk at 1-800-985-3059.

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

ADDITIONAL STATE-LAW PROTECTIONS FOR PATIENTS WITH STATE-REGULATED HEALTH PLANS:

• California law AB 72 protects consumers from surprise medical bills when they get non-emergency services, go to an in-network health facility, and receive care from an out-of-network provider without their consent. Facilities include hospitals, ambulatory surgery centers or other outpatient settings, laboratories, and radiology and imaging centers.
  • In this case, the law states that consumers only have to pay their -network cost sharing (co-pays, co-insurance or deductibles).
  • Medical providers are prohibited from sending consumers out-of-network bills when the consumer followed their health insurer's requirements and received non-emergency services in an in-network facility.
  • Consumers following their health insurer's requirements are protected from having their credit hurt, wages garnished, or liens placed on their primary residence.
  • If you have a health insurance policy with an out-of-network benefit, such as a PPO, you can choose to go to an out-of-network provider. If you go to an in-network facility and want to see an out-of-network provider, you have to give your permission in writing by signing a form provided by the out-of-network provider at least 24 hours before you receive care. The form must be separate from any other document used to obtain consent for any other part of the care or procedure and should inform you that you can receive care from an in-network provider if you choose. At the time consent is provided, the out-of-network provider shall give the consumer a written estimate of the consumer's total out-of-pocket cost of care. 
• California law AB 716 prohibits ground ambulance providers from balance billing enrollees and prohibits such providers from attempting to collect from an enrollee amounts greater than the in- network cost-sharing amount owed by the enrollee.

ADDITIONAL STATE GUIDANCE:

California’s laws addressing surprise and balance billing apply to people with health insurance policies or plans regulated by the Department of Insurance or the California Department of Managed Health Care that were issued, amended, or renewed on or after July 1, 2017. It does not apply to Medi-Cal plans, Medicare plans or self-insured plans. If you do not know what kind of plan you have, you can call the Department of Insurance Help Center at 1-800-927-4357 or visit https://www.insurance.ca.gov/01-consumers/101-help/index.cfm.

FILING A COMPLAINT:

If you get a surprise bill for more than your in-network cost share (co-pay, co-insurance or deductible), file a grievance/complaint with your health plan or insurer and include a copy of the bill. Your health plan or insurer will review your grievance and should tell the provider to stop billing you.

If you do not agree with your health plan’s response or they take more than 30 days to fix the problem, you can file a complaint with the Department of Managed Health Care, the state regulator of health plans. You can file a complaint by visiting www.HealthHelp.ca.gov or calling 1-888-466-2219.

If you do not agree with your health insurer's response or would like help from the California Department of Insurance to fix the problem, you can file a complaint with us online at https://www.insurance.ca.gov/01-consumers/101-help/index.cfm or by calling 1-800-927-4357.

STATE AGENCY CONTACT INFORMATION:

California Department of Managed Health Care (For Health Plans)

PHONE: 1-888-466-2219

WEBSITE: www.HealthHelp.ca.gov

California Department of Insurance (For Health Insurance)

PHONE: 1-800-927-4357

WEBSITE: https://www.insurance.ca.gov/01-consumers/101-help/index.cfm

ADDITIONAL INFORMATION:

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

ADDITIONAL STATE-LAW PROTECTIONS FOR PATIENTS WITH STATE-REGULATED HEALTH PLANS:

• Ambulance Information: Balance billing claims related to services provided by air ambulances are governed by federal law. Services provided by ground ambulances are regulated by Colorado state law and do not allow private companies to balance bill. However, you may be balance billed for emergency services you receive if the ambulance service  provider is a publicly funded fire agency or if the ambulance services are for a non-emergency, such as ambulance transport between hospitals, that is not a post-stabilization service
• Transferring Enrollees: Starting in 2025, Colorado Law will also prohibit providers and facilities from balance billing “transferring enrollees” for certain services until the earlier of the end of the current episode of treatment or until ninety days after the enrollee is covered by a new health benefit plan. “Transferring enrollees” include individuals:
  •  previously enrolled in Medicaid or the Children's Basic Health Plan but that are no longer eligible for benefits; or
  • enrolled in a new health plan when their prior health benefit plan coverage has not been renewed because the carrier no longer offers any health benefit plans that the individual is eligible for and if the individual is:
    • undergoing a course of treatment for a serious and complex medical condition that is treated by the provider or facility;
    • undergoing a course of inpatient care provided by the provider or facility;
    • pregnant and undergoing a course of treatment for the pregnancy provided by the provider or facility;
    • terminally ill and is receiving treatment for the illness from the provider or facility; or
    • scheduled to undergo nonelective surgery from the provider or facility, including the receipt of postoperative care from the provider or facility with respect to the surgery.

FILING A COMPLAINT:

If you believe you've been wrongly billed, please contact your insurance company  at the number on your ID card, or the Division of Insurance at 1-303-894-7490, 1-800-930-3745, or DORA_Insurance@state.co.us.

STATE AGENCY CONTACT INFORMATION:

Colorado Division of Insurance

PHONE: 1-303-894-7490, 1-800-930-3745

WEBSITE: https://doi.colorado.gov/insurance-products/health-insurance/health-insurance-initiatives/federal-no-surprises-act/colorado

ADDITIONAL INFORMATION:

Visit DOI Out-of-Network website at https://doi.colorado.gov/insurance-products/health-insurance/health-insurance-initiatives/federal-no-surprises-act/colorado for more information about your rights under Colorado state law.

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

ADDITIONAL STATE-LAW PROTECTIONS FOR PATIENTS WITH STATE-REGULATED HEALTH PLANS:

Connecticut passed its own NSA law in 2015 that requires health carriers (e.g., insurers and HMOs) regulated by the Department of Insurance to (1) bill covered persons (e.g., insureds) at the in-network level for services rendered that resulted in a surprise bill and (2) provide them notice about surprise bills in policy documents and on the carriers’ websites. Surprise bills are generally those that are unexpected and charged by providers who are not in the carriers’ networks. The law prohibits health care providers from requesting payment, except for a copayment, deductible, coinsurance, or other out-of-pocket expense, from an insured for a surprise bill. In Connecticut, a “surprise bill” is a bill for non-emergency health care services received by an insured for services rendered by the following:

1. an out-of-network clinical laboratory if the insured was referred by an in-network provider or
2. an out-of-network provider at an in-network facility during a service or procedure that was performed by an in-network provider or previously approved by the health carrier, and the insured did not knowingly elect to receive the services from the out-of-network provider.

A bill is not a surprise bill if an in-network provider is available but an insured knowingly elects to receive services from an out-of-network provider.

FILING A COMPLAINT:

The Connecticut Insurance Department intends to continue its responsibilities and commitment to protect consumers, including receiving complaints from consumers on issues related to the NSA and Connecticut Surprise Billing laws. These complaints may concern health plans and health care providers and facilities and may be referred, as appropriate, to other state or federal agencies for investigation and enforcement. Contact the Insurance Department’s Consumer Affairs Division to File a Complaint or Ask a Question at https://portal.ct.gov/cid/file-a-complaint?language=en_US.

STATE AGENCY CONTACT INFORMATION:

Connecticut Insurance Department’s Consumer Affairs Division

PHONE: 1-800-203-3447 or 1-860-297-3900

WEBSITE: https://portal.ct.gov/cid  

ADDITIONAL INFORMATION:

More information on that state law is available at Conn. Gen. Stat. §§ 38a-477aa and 20-7f or the Connecticut Department of Insurance website at portal.ct.gov/CID/General-Consumer-Information/No-Surprises-Act.

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

ADDITIONAL STATE-LAW PROTECTIONS FOR PATIENTS WITH STATE-REGULATED HEALTH PLANS:

• Facility-based providers and health care providers may not balance bill covered patients for health care services not covered by an insured’s health insurance contract if they failed to provide certain written out-of-network disclosures to the covered person or failed to obtain consent from the patient prior to services.
• Prior to the delivery of non-emergency covered services to a covered person, an Out-of-network health care providers must provide covered persons with a timely, written out-of-network disclosure prior to services.
• When a facility-based provider (a provider in an in-patient or ambulatory facility, including services such as pathology, anesthesiology, or radiology) or a health care provider requests a laboratory service for a covered person that does not require an in-person visit, the provider must provide certain disclosures to the covered person if the facility being utilized is an out-of-network facility. If the requesting provider does not provide the required disclosure to the covered person, the covered person may not be subject to any balance billing of the out-of-network service(s). If the laboratory service being requested requires an in-person visit, the laboratory must provide the covered person a written disclosure of the out-of-network service(s) and a consent form prior to rendering any service(s). If the laboratory does not provide the required disclosure to the covered person, the covered person shall not be subject to any balance billing.

FILING A COMPLAINT:

You may file a complaint with the federal government through the U.S. Department of Health and Human Services at https://www.cms.gov/nosurprises/consumers or by calling 1-800-985-3059.

ADDITIONAL INFORMATION:

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

FILING A COMPLAINT:

If you have received a surprise medical bill, you may call the Office of the Attorney General’s Office of Consumer Protection at 1-202-442-9828, submit a complaint at consumer.protection@dc.gov or fill out an online form at https://dcoag.my.site.com/dcoagcomplaints/s/?language=en_US.

STATE AGENCY CONTACT INFORMATION:

Office of the Attorney General for the District of Columbia

PHONE: 1-202-442-9828

WEBSITE: https://oag.dc.gov/blog/surprise-medical-bills-are-now-illegal

ADDITIONAL INFORMATION:

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

ADDITIONAL STATE-LAW PROTECTIONS FOR PATIENTS WITH STATE-REGULATED HEALTH PLANS:

Nonparticipating providers may not collect or attempt to collect any excess amount from insureds directly or indirectly (other than copayments, coinsurance, and deductibles) for:

• Covered emergency services provided in accordance with the coverage terms of an insured’s health insurance policy
• Nonemergency services provided in a contracted facility which the facility would be otherwise obligated to provide under contract with the insurer
• Nonemergency services when the insured does not have the ability and opportunity to choose a participating provider at the facility who is available to treat the insured

FILING A COMPLAINT:

You may file a complaint with the federal government through the U.S. Department of Health and Human Services at https://www.cms.gov/nosurprises/consumers or by calling 1-800-985-3059.

STATE AGENCY CONTACT INFORMATION:

Florida Agency for Health Care Administration

PHONE: 1-888-419-3456

WEBSITE: https://apps.fldfs.com/eservice/Default.aspx

ADDITIONAL INFORMATION:

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

ADDITIONAL STATE-LAW PROTECTIONS FOR PATIENTS WITH STATE-REGULATED HEALTH PLANS & OPT-IN PROVISION:

Under Georgia’ Surprise Billing Consumer Protection Act:

• In the event a covered person receives the provision of emergency medical services from a nonparticipating emergency medical provider or emergency medical services from a nonparticipating facility, the nonparticipating provider or nonparticipating facility may not collect or bill more than the covered person's deductible, coinsurance, copayment, or other cost-sharing amount as determined by the person's policy directly.
• In the event a covered person receives a surprise bill for the provision of nonemergency medical services from a nonparticipating medical provider, the nonparticipating provider shall collect or bill the covered person no more than such person's deductible, coinsurance, copayment, or other cost-sharing amount as determined by such person's policy directly.
• Georgia defines:
  • A “surprise bill” as a bill resulting from an occurrence in which charges arise from a covered person receiving healthcare services from an out-of-network provider at an in-network facility
  • A “provider” as any physician, other individual, or facility other than a hospital licensed or otherwise authorized in this state to furnish healthcare services, including, but not limited to, any dentist, podiatrist, optometrist, psychologist, clinical social worker, advanced practice registered nurse, registered optician, licensed professional counselor, physical therapist, marriage and family therapist, chiropractor, athletic trainer, occupational therapist, speech-language pathologist, audiologist, dietitian, or physician assistant
  • A "facility" as a hospital, an ambulatory surgical treatment center, birthing center, diagnostic and treatment center, hospice, or similar institution

Self-funded plans may opt-in to Georgia’s Surprise Billing Consumer Protection Act.

FILING A COMPLAINT:

If you think you’ve been sent a bill you should not have to pay, file a complaint with your insurer. Then file a complaint with the Office of the Commissioner of Insurance and Safety Fire online at https://gaoci.govlink.us/surprise-billing/home or at 1-404-656-2070.

STATE AGENCY CONTACT INFORMATION:

Georgia Office of the Commissioner of Insurance and Safety Fire 

PHONE: 1-404-656-2070

WEBSITE: https://gaoci.govlink.us/surprise-billing/home

ADDITIONAL INFORMATION:

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

FILING A COMPLAINT:

You may file a complaint with the federal government through the U.S. Department of Health and Human Services at https://www.cms.gov/nosurprises/consumers or by calling 1-800-985-3059.

ADDITIONAL INFORMATION:

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

FILING A COMPLAINT:

If you believe you’ve been wrongly billed, you may contact Idaho Department of Insurance by visiting the department's website at doi.idaho.gov/nosurprises or calling the Consumer Affairs section at 1-208-334-4319 or toll-free in Idaho at 1-800-721-3272.

You may file a complaint with the federal government through the U.S. Department of Health and Human Services at https://www.cms.gov/nosurprises/consumers or by calling 1-800-985-3059.

STATE AGENCY CONTACT INFORMATION:

Idaho Department of Insurance

PHONE: 1-208-334-4319

WEBSITE: doi.idaho.gov/nosurprises

ADDITIONAL INFORMATION:

Visit doi.idaho.gov/nosurprises for more information about your rights under the No Surprises Act.

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

ADDITIONAL STATE-LAW PROTECTIONS FOR PATIENTS WITH STATE-REGULATED HEALTH PLANS:

Nonparticipating providers may not bill enrollees for any amount beyond cost-sharing:

• When an enrollee utilizes a participating health care facility and, due to any reason, covered ancillary services are provided by a nonparticipating provider during or resulting from the visit
• When an enrollee receives emergency services from a nonparticipating provider or a nonparticipating emergency facility 

FILING A COMPLAINT:

You may file a complaint with the federal government through the U.S. Department of Health and Human Services at https://www.cms.gov/nosurprises/consumers or by calling 1-800-985-3059.

STATE AGENCY CONTACT INFORMATION:

Illinois Department of Insurance

PHONE: 1-877-527-9431

WEBSITE: https://idoi.illinois.gov/aboutus/contactus.html#:~:text=We%20encourage%20consumers%20to%20continue,to%20address%20their%20particular%20issue

ADDITIONAL INFORMATION:

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

ADDITIONAL STATE-LAW PROTECTIONS FOR PATIENTS WITH STATE-REGULATED HEALTH PLANS:

• Starting in 2025, Indiana will also prohibit nonparticipating ground ambulance providers from balancing billing in certain circumstances.

FILING A COMPLAINT:

You may file a complaint and submit an appeal to the Indiana Department of Insurance. You may file a complaint with the federal government through the U.S. Department of Health and Human Services at https://www.cms.gov/nosurprises/consumers or by calling 1-800-985-3059.

Starting in 2025, contact the Indiana Department of Insurance to submit a complaint related to ground ambulance providers at https://www.in.gov/idoi/consumer-services/file-a-insurance-company-complaint/.

ADDITIONAL INFORMATION:

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

FILING A COMPLAINT:

If you believe you’ve been wrongly billed by your provider or an insurance company, Iowa residents may contact the Iowa Insurance Division at https://live-iid-iowa-gov.pantheonsite.io/locations/iowa-insurance-division. You may also contact the Department of Health and Human Services at 1-800-985-3059 regarding how to dispute a medical bill through the federal dispute resolution process.

You may file a complaint with the federal government through the U.S. Department of Health and Human Services at https://www.cms.gov/nosurprises/consumers or by calling 1-800-985-3059.

STATE AGENCY CONTACT INFORMATION:

Iowa Insurance Division

PHONE: 877-955-1212

WEBSITE: https://iid.iowa.gov/no-surprises-act

ADDITIONAL INFORMATION:

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

FILING A COMPLAINT:

If you have questions or concerns about a medical bill and whether it was properly billed, please visit the Kansas Department of Insurance online at insurance.kansas.gov/complaint or call 1-800-432-2484.

STATE AGENCY CONTACT INFORMATION:

Kansas Department of Insurance

PHONE: 1-800-432-2484

WEBSITE: https://insurance.kansas.gov/complaint/

ADDITIONAL INFORMATION:

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

FILING A COMPLAINT:

If you receive a surprise billing, contact your insurer and the Department of Insurance (DOI) at 800-595-6053. You may file a complaint with the federal government through the U.S. Department of Health and Human Services at https://www.cms.gov/nosurprises/consumers or by calling 1-800-985-3059.

STATE AGENCY CONTACT INFORMATION:

Kentucky Department of Insurance

PHONE: 1-800-595-6053

WEBSITE: https://insurance.ky.gov/ppc/New_Docs.aspx?cat=25&menuid=15

ADDITIONAL INFORMATION:

Examples of how the new protections apply can be found on the DOI website at https://insurance.ky.gov/ppc/Documents/nsa%20-%20consumer%20bulletin%2012-2021.pdf
Kentuckians can call the No Surprises Act help desk at 1-800-985-3059 or visit the federal website at https://www.cms.gov/nosurprises for helpful resources.  

ADDITIONAL STATE-LAW DISCLOSURES

Louisiana law specifies the following:

Professional services rendered by independent healthcare professionals are not part of the hospital bill. These services will be billed to the patient separately. Please understand that physicians or other healthcare professionals may be called upon to provide care or services to you or on your behalf, but you may not actually see, or be examined by, all physicians or healthcare professionals participating in your care; for example, you may not see physicians providing radiology, pathology, and EKG interpretation. In many instances, there will be a separate charge for professional services rendered by physicians to you or on your behalf, and you will receive a bill for these professional services that is separate from the bill for hospital services. These independent healthcare professionals may not participate in your health plan and you may be responsible for payment of all or part of the fees for the services provided by these physicians who have provided out-of-network services, in addition to applicable amounts due for copayments, coinsurance, deductibles, and non-covered services.

We encourage you to contact your health plan to determine whether the independent healthcare professionals are participating with your health plan. In order to obtain the most accurate and up-to-date information about in-network and out-of-network independent healthcare professionals, please contact the customer service number of your health plan or visit its website. Your health plan is the primary source of information on its provider network and benefits. To help you determine whether the independent healthcare professionals who provide services at this facility are participating with your health plan, this healthcare facility has provided you with a complete list of the names and contact information for each individual or group.

FILING A COMPLAINT:

You may file a complaint with the federal government through the U.S. Department of Health and Human Services at https://www.cms.gov/nosurprises/consumers or by calling 1-800-985-3059.

ADDITIONAL INFORMATION:

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

ADDITIONAL STATE-LAW PROTECTIONS FOR PATIENTS WITH STATE-REGULATED HEALTH PLANS:

Under Maine’s “Act To Protect Maine Consumers from Unexpected Medical Bills,” an out-of-network provider may not bill an enrollee for health care services beyond the applicable coinsurance, copayment, deductible or other out-of-pocket cost expense that would be imposed if in-network for surprise bills, bills for covered emergency services, or for bills for COVID-19 screening and testing. A “surprise bill” is a bill for health care services received by an enrollee for covered services rendered by an out-of-network provider, when the services were rendered at a network provider, during a service or procedure performed by a network provider, or during a service or procedure previously approved or authorized by the carrier and the enrollee did not knowingly elect to obtain such services from that out-of-network provider.  

FILING A COMPLAINT:

If you believe you’ve been wrongly billed, you may contact your insurance carrier by calling the number on your insurance card. You may also file a complaint with the Maine Bureau of Insurance at https://www.maine.gov/pfr/insurance/consumers/file-a-complaint-dispute.

STATE AGENCY CONTACT INFORMATION:

Maine Bureau of Insurance

PHONE: 1-207-624-8475, or 1-800-300-5000 (toll-free)

WEBSITE: https://www.maine.gov/pfr/insurance/about/contact

ADDITIONAL INFORMATION:

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

ADDITIONAL STATE-LAW PROTECTIONS FOR PATIENTS WITH STATE-REGULATED HEALTH PLANS:

• If you are in a Health Maintenance Organization (HMO) governed by Maryland law, you may not be balance billed for services covered by your plan, including ground ambulance services.
• If you are in a PPO or EPO governed by Maryland law, hospital-based or on-call physicians paid directly by your PPO or EPO (assignment of benefits) may not balance bill you for services covered under your plan and can’t ask you to waive your balance billing protections.
• If you use ground ambulance services operated by a local government provider who accepts an assignment of benefits from a plan governed by Maryland law, the provider may not balance bill you.

FILING A COMPLAINT:

• If you believe you’ve been wrongly billed, call or email the Health Education and Advocacy Unit (HEAU) of Maryland’s Consumer Protection Division for more information, or file a complaint, visit https://www.marylandattorneygeneral.gov/Pages/CPD/HEAU/compOLBillEquipDispute.aspx:

Health Education and Advocacy Unit

Office of the Attorney General

200 St Paul Place, 16th Floor

Baltimore, Maryland 21202

PHONE: (410) 528-1840 or toll-free 1 (877) 261-8807

En español: 410-230-1712

Fax: (410) 576-6571

heau@oag.state.md.us

WEBSITE: http://www.marylandattorneygeneral.gov/Pages/CPD/HEAU

• If you believe your health plan processed your claim incorrectly, you may contact the Maryland Insurance Administration:
  Maryland Insurance Administration Life and Health Complaints Unit 200 St Paul Place, Suite 2700
  Baltimore, Maryland 21202
  Phone (410) 468-2000 or toll free 1-(800) 492-6116
  Fax: (410)468-2260

WEBSITE: http://www.insurance.maryland.gov

STATE AGENCY CONTACT INFORMATION:

Maryland Health Education and Advocacy Unit, Office of the Attorney General

PHONE: 1-410-528-1840

WEBSITE: https://www.marylandattorneygeneral.gov/Pages/CPD/HEAU/NSA.aspx#2  

ADDITIONAL INFORMATION:

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law. Visit marylandattorneygeneral.gov or insurance.maryland.gov for more information about your rights under Maryland law.

FILING A COMPLAINT:

Consumers with questions about a surprise bill can contact the Division of Insurance by filling out a complaint form DOI Insurance Complaint Submission Form at https://www.mass.gov/how-to/filing-an-insurance-complaint, e-mailing CSSComplaints@mass.gov, or by calling 1-877-563-4467 and selecting Option 2.

STATE AGENCY CONTACT INFORMATION:

Massachusetts Division of Insurance

PHONE: 1-877-563-4467

WEBSITE: https://www.mass.gov/how-to/filing-an-insurance-complaint   

ADDITIONAL INFORMATION:

Consumers can also contact the Centers for Medicare and Medicaid Services (CMS) to learn more at https://www.cms.gov/nosurprises/consumers/complaints-about-medical-billing, or by calling 1- 800-985-3059.

ADDITIONAL STATE-LAW PROTECTIONS FOR PATIENTS WITH STATE-REGULATED HEALTH PLANS:

• Under certain circumstances established in Michigan’s surprise medical billing law, out-of-network providers are not allowed to bill you for an amount greater than your applicable in-network coinsurance, copay, or deductible. Instead of billing you, the out-of-network provider must submit a claim to your insurer for an amount that is established in the law. Generally, the prohibition on surprise billing applies to covered health care services provided to you by an out-of-network provider in an emergency situation.
• Additionally, out-of-network providers are prohibited from surprise billing you in a non-emergency situation if you are treated at a participating health facility and if you did not have the ability or opportunity to choose an in-network provider. Out-of-network providers must give you a disclosure before providing the non-emergency health care service. The disclosure must notify you that your health insurer may not provide coverage for all of the scheduled health care services and that you may be responsible for the cost of the services. The disclosure must also state that the provider will give you a good faith estimate of the cost of the health care services and inform you of your right to request an in-network provider and to contact your insurer for information on in-network services. If the out-of-network provider fails to give you the disclosure before your non-emergency service, as required under the law, the out-of-network provider is prohibited from billing you for any amount greater than your applicable in-network coinsurance, copay, or deductible.
• Additionally, Michigan law states if you consent to receive nonemergency care from an out-of-network provider, the balance billing prohibition does not apply. These protections apply to any patient covered by a Michigan health benefit plan and a self-funded plan established or maintained by the state or local unit of government for its employees.
• Michigan’s surprise medical billing law applies to insurers that are regulated by DIFS, including plans purchased on the Health Insurance Marketplace. Self-funded group health plans offered by private employers are not subject to Michigan’s law but are generally required to comply with surprise billing protections established under the federal No Surprises Act (NSA). To learn more about consumer protections under the NSA, visit CMS.gov/NoSurprises.

FILING A COMPLAINT:

Consumers who do not receive the required disclosure form or who receive a surprise medical bill after receiving care should contact their health insurer as soon as possible. If a resolution cannot be reached, consumers can contact DIFS Monday through Friday 8 a.m. to 5 p.m. at 877-999-6442 or visit the DIFS website at https://www.michigan.gov/difs to file a complaint.

STATE AGENCY CONTACT INFORMATION:

Michigan Department of Insurance & Financial Services

PHONE: 877-999-6442

WEBSITE: https://www.michigan.gov/difs

ADDITIONAL INFORMATION:

DIFS can help you with health insurance questions and complaints and can provide general information about Michigan’s surprise medical billing law. 

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

ADDITIONAL STATE-LAW PROTECTIONS FOR PATIENTS WITH STATE-REGULATED HEALTH PLANS:

Under Minnesota’s “Consumer Protections Against Balance Billing”:

• Balance billing is prohibited when an enrollee receives services from: 
  • a nonparticipating provider at a participating hospital or ambulatory surgical center, as described by the No Surprises Act
  • a participating provider that sends a specimen taken from the enrollee in the participating provider's practice setting to a nonparticipating laboratory, pathologist, or other medical testing facility; or
  • a nonparticipating provider or facility providing other services as described in the requirements of the No Surprises Act and emergency services with respect to an emergency medical condition, including an immediate response service available on a 24-hour, seven-day-a-week basis for persons having a psychiatric crisis, a mental health crisis, or emergency or for each child having a psychiatric crisis, a mental health crisis, or a mental health emergency
• The services described above are subject to balance billing if the enrollee provides informed consent prior to receiving services from the nonparticipating provider acknowledging that the use of a provider, or the services to be rendered, may result in costs not covered by the health plan. The informed consent must comply with all requirements of the No Surprises Act.

FILING A COMPLAINT:

If you’ve received a surprise bill and you believe your health plan is not following the No Surprises Act, you can file an appeal with your health plan or ask for an external review of its decision. You can also file a complaint with the Minnesota Department of Health at https://www.health.state.mn.us/facilities/insurance/managedcare/complaint/index.html or the Minnesota Department of Commerce at https://mn.gov/commerce/consumer/file-a-complaint/.  

STATE AGENCY CONTACT INFORMATION:

Minnesota Department of Health

PHONE: 1-651-201-5100

WEBSITE: https://www.health.state.mn.us/facilities/insurance/managedcare/faq/nosurprisesact.html

ADDITIONAL INFORMATION:

For more information, email health.mcs@state.mn.us.

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

ADDITIONAL STATE-LAW PROTECTIONS FOR PATIENTS WITH STATE-REGULATED HEALTH PLANS:

Under MS Code 83-9-5 (1)(i), if an out-of-network healthcare provider accepts a patient's insurance assignment, then the insurance company will pay the provider directly for the patient's treatment. That payment is considered payment in full to the healthcare provider - this means the provider cannot bill the patient later for any amount more than the payment received from the insurance company, other than normal deductibles or co-pays. You may ask what an assignment is. Assignment means that your physician agrees to accept your insurance company's rates as full payment for services covered by insurance. MS Code 83-9-5 (1)(i) does not apply to dentists.

FILING A COMPLAINT:

If you believe you’ve been wrongly billed, you may contact Mississippi Insurance Department, (601) 359-3569 or compliance@mid.ms.gov.

You may file a complaint with the federal government through the U.S. Department of Health and Human Services at https://www.cms.gov/nosurprises/consumers or by calling 1-800-985-3059.

STATE AGENCY CONTACT INFORMATION:

Mississippi Insurance Department

PHONE: 1-601-359-3569

WEBSITE: https://www.mid.ms.gov/

ADDITIONAL INFORMATION:

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

FILING A COMPLAINT:

If you think the protections have not been applied correctly, you can file an appeal with your insurance company or request external review of the company’s decision. You can also file a complaint with the Missouri Department of Commerce and Insurance at https://insurance.mo.gov/ or the federal Department of Health and Human Services. You can get more information and make complaints to federal agencies by calling 1-800-985-3059 or by visiting https://www.cms.gov/nosurprises/consumers/complaints-about-medical-billing.

STATE AGENCY CONTACT INFORMATION:

Missouri Department of Commerce & Insurance

PHONE: 1-800-726-7390

WEBSITE: https://insurance.mo.gov/consumers/health/no-surprises-act.php#

ADDITIONAL INFORMATION:

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

FILING A COMPLAINT:

If you have questions or complaints, please reach out to the Montana Commissioner of Securities & Insurance—Policyholder Services at 406-444-2040.

You may file a complaint with the federal government through the U.S. Department of Health and Human Services at https://www.cms.gov/nosurprises/consumers or by calling 1-800-985-3059.

STATE AGENCY CONTACT INFORMATION:

Montana Commissioner of Securities & Insurance

PHONE: 406-444-2040

WEBSITE: https://csimt.gov/2022/09/15/no-surprises-act/

ADDITIONAL INFORMATION:

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

ADDITIONAL STATE-LAW PROTECTIONS FOR PATIENTS WITH STATE-REGULATED HEALTH PLANS:

In addition to the federal No Surprises Act, Nebraska statutes include a protection from balance billing in emergency situations, called “The Out-Of-Network Emergency Medical Care Act” at Neb. Rev. Stat. § § 44-6834 to 44-6850. 

FILING A COMPLAINT:

The Nebraska Department of Insurance (NDOI) will be the initial point of contact for complaints about No Surprises Act noncompliance at DOI.ExternalReview@nebraska.gov.

STATE AGENCY CONTACT INFORMATION:

Nebraska Department of Insurance

PHONE: 1-402-471-2201

WEBSITE: https://doi.nebraska.gov/consumer/no-surprises-act-new-protection-surprise-balance-bills  

ADDITIONAL INFORMATION:

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

ADDITIONAL STATE-LAW PROTECTIONS FOR PATIENTS WITH STATE-REGULATED HEALTH PLANS AND CERTAIN OTHER PLANS:

Nevada has laws in place that prohibit balance billing to the covered person in certain emergency situations at Nev. Rev. Stat. §§ 439B.700 - 439B.760. The NSA covers everything protected under current Nevada state law and more. In situations where the state has stricter statutes to protect consumers, or rules in place determining the rate of compensation due to the out-of-network providers, the federal law defers to the state law. Nev. Rev. Stat. § 439.757 allows ERISA plans to opt-in, or not, to Nevada’s balance billing statutes.

FILING A COMPLAINT:

You may file a complaint with the federal government through the U.S. Department of Health and Human Services at https://www.cms.gov/nosurprises/consumers or by calling 1-800-985-3059.

STATE AGENCY CONTACT INFORMATION:

Nevada Division of Insurance

PHONE: 1-702-486-4009   

WEBSITE: https://doi.nv.gov/Consumers/Health_and_Accident_Insurance/Balance_Billing_FAQs/

ADDITIONAL INFORMATION:

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

ADDITIONAL STATE-LAW PROTECTIONS FOR PATIENTS WITH STATE-REGULATED HEALTH PLANS:

• Until December 31, 2024: New Hampshire’s balance billing law is narrower in scope than the NSA and prohibits out-of-network anesthesiologists, pathologists, radiologists and emergency physicians from balance billing a commercially insured patient when the care was provided at an in-network hospital. The NSA expands the prohibition against balance billing to all emergency care, out-of-network providers at in-network facilities and air ambulatory providers. The New Hampshire Insurance Department will ONLY enforce the NSA’s balance billing prohibitions when the circumstance involves emergency and pathology, as well as radiology and anesthesiology for in-network facilities in the state in non-emergency cases. In all other cases, CMS will enforce.
• Starting January 1, 2025: On, New Hampshire’s new balance billing law (SB173) will go into effect on January 1, 2025.  The law aligns with the NSA by enacting the same requirements and prohibitions at the state level. However, in addition to the protections under the NSA, under New Hampshire’s definition of “facility,” New Hampshire’s balance billing law will also apply the protections  for non-emergency services furnished by non-participating providers more broadly to institutions providing health care services and health care settings, including but not limited to hospitals and other licensed inpatient centers, ambulatory surgical or treatment centers, skilled nursing centers, residential treatment centers, diagnostic, laboratory and imaging centers, and rehabilitation and other therapeutic health settings. 

FILING A COMPLAINT:

If you have received a surprise bill that you think is not allowed under the new law, you can file an appeal with your insurance company or ask for an external review of the company’s decision.

You may file a complaint with the federal government through the U.S. Department of Health and Human Services at https://www.cms.gov/nosurprises/consumers or by calling 1-800-985-3059.

STATE AGENCY CONTACT INFORMATION:

New Hampshire Insurance Department Consumer Services Department

PHONE: 1-603-271-2261

WEBSITE: www.NH.gov/insurance

ADDITIONAL INFORMATION:

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

ADDITIONAL STATE-LAW PROTECTIONS FOR PATIENTS WITH STATE-REGULATED HEALTH PLANS AND CERTAIN OTHER PLANS:

Under New Jersey’s “Out-of-network Consumer Protection, Transparency, Cost Containment, and Accountability Act:

• Health care providers are prohibited from balance billing a covered person for inadvertent out-of-network services and/or out-of-network services provided on an emergency or urgent basis above the amount of the covered person’s liability for in-network cost-sharing (i.e. the covered person’s network level deductible, copayments, or coinsurance).  
  •  “Inadvertent out-of-network services,” means health care services that are: covered under a health benefits plan that provides a network; and are provided by an out-of-network health care provider in an in-network health care facility when in-network health care services are unavailable in that facility or are not made available to the covered person. "Inadvertent out-of-network services" also includes laboratory testing ordered by an in-network health care provider and performed by an out-of-network bio-analytical laboratory; and
  • “Emergency or Urgent basis” means all emergency and urgent care services.
• Out-of-network arbitration: The Act creates an arbitration process to resolve out-of-network billing disputes for inadvertent and/or emergency/urgent out-of-network services. More information about arbitration, and the process for initiating the arbitration process, can be found at the Department’s arbitration vendor’s website at  https://dispute.maximus.com/nj/indexNJ.
• Self-funded plans that opt in and providers - A self-funded plan may opt to be subject to the claims processing and arbitration provisions and be subject to the same arbitration process as carriers in the insured markets.
• Members of self-funded plans that do not opt in and providers - The process to initiate arbitration by members of self-funded plans that do not elect to the subject to this law  (or “opt-in” to the law) is described at https://dispute.maximus.com/nj/OonFAQ.

FILING A COMPLAINT:

Any attempts by the out-of-network health care provider to bill the covered person for these types of services above the covered person’s in-network cost-sharing liability should be reported to the covered person’s carrier, and a complaint may be filed with the appropriate provider’s licensing board or other regulatory body, as appropriate. 

A complaint may also be filed with the New Jersey Department of Banking & Insurance at https://www.nj.gov/dobi/consumer.htm. The Department will investigate the complaint and when appropriate, refer the matter to the appropriate licensing agency or regulatory body for review.   

STATE AGENCY CONTACT INFORMATION:

Department of Banking & Insurance

PHONE: 1-800-446-7467

WEBSITE: https://www.nj.gov/dobi/consumer.htm

ADDITIONAL INFORMATION:

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

ADDITIONAL STATE-LAW PROTECTIONS FOR PATIENTS WITH STATE-REGULATED HEALTH PLANS:

Under New Mexico’s “Surprise Billing Protection Act”:

• Nonparticipating providers (including health care professionals, hospitals, or other facilities licensed to furnish healthcare services) may not knowingly submit a surprise bill to a covered person.
  • A “surprise bill” is a bill that a nonparticipating provider issues to a covered person for health care services rendered in the following circumstances, in an amount that exceeds the covered person's cost-sharing obligation that would apply for the same health care services if these services had been provided by a participating provider:
    • emergency care provided by the nonparticipating provider; or
    • health care services, that are not emergency care, rendered by a nonparticipating provider at a participating facility where:
      • a participating provider is unavailable;
      • a nonparticipating provider renders unforeseen services; or
      • a nonparticipating provider renders services for which the covered person has not given specific consent for that nonparticipating provider to render the particular services rendered
• The following are not considered “surprise bills”:
  • Health care services received by a covered person when a participating provider was available to render the health care services and the covered person knowingly elected to obtain the services from a nonparticipating provider without prior authorization
  • Health care services rendered by a nonparticipating provider to a covered person whose coverage is provided pursuant to a preferred provider plan; provided that the health care services are not provided as emergency care or for services rendered pursuant to Subparagraph (b) of Paragraph (1) of this subsection.
• A “facility is an entity providing health care services that includes a laboratory, a health care provider's office or clinic; a general, special, psychiatric or rehabilitation hospital; an ambulatory surgical center; a cancer treatment center; a birth center; an inpatient, outpatient or residential drug and alcohol treatment center; diagnostic or other outpatient medical service or testing center; an urgent care center; a freestanding emergency room; any other therapeutic health care setting

FILING A COMPLAINT:

If you get a bill from an out-of-network provider that you do not believe is owed, contact the New Mexico Office of Superintendent of Insurance – www.osi.state.nm.us or 1-855-4ASK-OSI (1-855-427-5674).

STATE AGENCY CONTACT INFORMATION:

New Mexico Office of Superintendent of Insurance

PHONE: 1-855-4-ASK-OSI (1-855-427-5674)

WEBSITE: https://www.osi.state.nm.us/pages/bureaus/consumer/resources/consumer-assistance. 

ADDITIONAL INFORMATION:

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

ADDITIONAL STATE-LAW PROTECTIONS FOR PATIENTS WITH STATE-REGULATED HEALTH PLANS:

• For emergency services: If your insurance ID card says “fully insured coverage,” you can’t give written consent and give up your protections not to be balance billed for post-stabilization services.
• For non-emergency services: If your insurance ID card says “fully insured coverage,” you can’t give up your protections for services at in-network facilities if they are a surprise bill. Surprise bills under New York law are when you’re at an in-network hospital or ambulatory surgical facility and a participating doctor was not available, a non-participating doctor provided services without your knowledge, or unforeseen medical services were provided.
• For services referred by your in-network doctor: If your insurance ID card says “fully insured coverage,” surprise bills include when your in-network doctor refers you to an out-of-network provider without your consent (including lab and pathology services). These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed. You may need to sign a form (available on the Department of Financial Services’ at https://www.dfs.ny.gov/system/files/documents/2022/01/Surprise_Medical_Bill_Certification_Form_2022.pdf) for the full balance billing protection to apply.

FILING A COMPLAINT:

If you think you’ve been wrongly billed and your coverage is subject to New York law (“fully insured coverage”), contact the New York State Department of Financial Services at 1-800-342-3736 or surprisemedicalbills@dfs.ny.gov.

STATE AGENCY CONTACT INFORMATION:

New York State Department of Financial Services

PHONE: 1-800-342-3736

WEBSITE: http://www.dfs.ny.gov

ADDITIONAL INFORMATION:

Visit http://www.dfs.ny.gov for information about your rights under state law.

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for self-funded coverage or coverage bought outside New York or for more information about your rights under federal law.

FILING A COMPLAINT:

You may file a complaint with the federal government through the U.S. Department of Health and Human Services at https://www.cms.gov/nosurprises/consumers or by calling 1-800-985-3059.

ADDITIONAL INFORMATION:

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

FILING A COMPLAINT:

If you have questions about surprise billing or receive something you are unsure of, please contact the North Dakota Insurance Department at (701) 328-2440 or insurance@nd.gov.

You may file a complaint with the federal government through the U.S. Department of Health and Human Services at https://www.cms.gov/nosurprises/consumers or by calling 1-800-985-3059.

STATE AGENCY CONTACT INFORMATION:

North Dakota Insurance Department

PHONE: 1-701-328-2440

WEBSITE: https://www.insurance.nd.gov/consumers/other-resources/no-surprises-act

ADDITIONAL INFORMATION:

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

ADDITIONAL STATE-LAW PROTECTIONS FOR PATIENTS WITH STATE-REGULATED HEALTH PLANS:

• Surprise billing happens when a patient receives an unexpected bill after unanticipated care from an out-of-network health care provider, which can occur at an in-network health care facility such as a hospital, or at an out-of-network health care facility. It can happen for both emergency and non-emergency care. Typically, patients are unaware that the health care provider or health care facility is out-of-network until they receive the bill.
• Emergency Situation: An individual with insurance has an unanticipated, medical emergency event requiring "emergency services". This individual is taken to an “out-of-network” health care facility and receives emergency care. Due to the emergency situation, the individual was unable to select an in-network health care provider.  Similarly, the individual is taken to an in-network health care facility but received emergency care from out-of-network health care providers working with that health care facility. Because of the emergency, the individual was unable to select an in-network health care facility or health care provider. "Emergency services" in both in-network and out-of-network settings mean the following, according to the law: 
  • Medical screening examinations to determine whether an emergency medical condition exists.
  • Treatment that is necessary to stabilize an emergency medical condition.
  • Appropriate transfers prior to an emergency medical condition stabilization.
• Non-Emergency Situation: An individual with insurance schedules an elective treatment or nonemergency care appointment with an in-network health care provider. During the scheduled visit to the health care provider's facility, the patient receives services from an out-of-network health care provider. This could be a service from a doctor or related to imaging, laboratory services, etc. The patient, after this "unanticipated out-of-network care" then receives a surprise bill for out-of-network services received even though the treatment occurred in an in-network health care facility. For additional treatment situation examples, including about consent, go to https://insurance.ohio.gov/consumers/surprise-billing/resources/surprise-billing-scenarios-protections-consumers . “Unanticipated out-of-network care" mean the following, according to the law:
  • Health care services covered under a health benefit plan and provided by an out-of-network health care provider when either of the following conditions applies:
  • The covered person did not have the ability to request such services from an in-network health care provider.
  • The services provided were emergency services.
• Ground Ambulance Situation: The Ohio law also protects consumers from ground ambulance surprise billing situations.

FILING A COMPLAINT:

If you receive a surprise bill that you believe is prohibited by state or federal law, first, try to resolve the dispute yourself with your health insurer and health care provider. If the dispute remains unresolved, contact the Ohio Department of Insurance through insurance.ohio.gov, consumer.complaint@insurance.ohio.gov, or 1-800-686-1526 to file a complaint.

STATE AGENCY CONTACT INFORMATION:

Ohio Department of Insurance

PHONE: 1-800-686-1526

WEBSITE: insurance.ohio.gov

ADDITIONAL INFORMATION:

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

FILING A COMPLAINT:

You may file a complaint with the federal government through the U.S. Department of Health and Human Services at https://www.cms.gov/nosurprises/consumers or by calling 1-800-985-3059.

ADDITIONAL INFORMATION:

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

ADDITIONAL STATE-LAW PROTECTIONS FOR PATIENTS WITH STATE-REGULATED HEALTH PLANS:

• Oregon’s balance billing law, ORS 743B.287, prohibits an out-of-network provider at an in-network facility from billing a patient for more than the patient’s in-network cost-sharing responsibility, subject to certain specified exceptions.

FILING A COMPLAINT:

If you believe you have received a surprise medical bill from a provider, contact the U.S. Department of Health and Human Services and file a complaint by calling 1-800-985-3059 (toll-free) or going to https://www.cms.gov/nosurprises/consumers. You may also contact Oregon’s Division of Financial Regulation to speak with a consumer advocate or file a complaint.

STATE AGENCY CONTACT INFORMATION:

Oregon Division of Financial Regulation

PHONE: 1-888-877-4894

WEBSITE: https://dfr.oregon.gov/help/complaints-licenses/Pages/file-complaint.aspx

ADDITIONAL INFORMATION:

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

ADDITIONAL STATE GUIDANCE:

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. Contact the Pennsylvania Insurance Department  at www.insurance.pa.gov/nosurprises or   by   phone   at   1-877-881-6388 or TTY/TDD: 717-783-3898 if you have difficulty finding a provider or facility in your plan’s network.

FILING A COMPLAINT:

If you believe you’ve been wrongly billed, you may contact the Pennsylvania Insurance Department at www.insurance.pa.gov/nosurprises or by phone at 1-877-881-6388 or TTY/TDD: 717-783-3898.

You may file a complaint with the federal government through the U.S. Department of Health and Human Services at https://www.cms.gov/nosurprises/consumers or by calling 1-800-985-3059.

STATE AGENCY CONTACT INFORMATION:

Pennsylvania Insurance  Department

PHONE: 1-877-881-6388

WEBSITE: www.insurance.pa.gov/nosurprises

ADDITIONAL INFORMATION:

Visit www.insurance.pa.gov/nosurprises for more information about your rights under federal and state law.

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

FILING A COMPLAINT:

You may file a complaint with the federal government through the U.S. Department of Health and Human Services at https://www.cms.gov/nosurprises/consumers or by calling 1-800-985-3059.

ADDITIONAL INFORMATION:

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

FILING A COMPLAINT:

The South Carolina Department of Insurance (SCDOI) has enforcement over issuers (insurance companies and HMOs), while providers and facilities will be under federal enforcement.

Consumers will have the right to appeal health plan denials and decisions that bill the patient for an amount higher than allowable under the provisions of the law. If the plan upholds its decision, an independent external reviewer will make a final determination.

If you believe you have received a surprise medical bill from a provider for the services specified above, you have several options to consider.

If your insurance is denying the claim, you can contact the Office of Consumer Services here at the SCDOI. Please call 803-737-6180 to speak with an Insurance Regulatory Analyst.  You can also email your question to consumers@doi.sc.gov or file an online complaint at https://sbs.naic.org/solar-web/pages/public/onlineComplaintForm/onlineComplaintForm.jsf?state=SC&dswid=9199  =. 

If your issue is with the provider or healthcare facility, contact the federal government by visiting CMS.gov/nosurprises to file a complaint or by calling 800-985-3059 (toll-free).

If your issue is with the provider or healthcare facility, contact the federal government by visiting https://www.cms.gov/nosurprises/consumers  to file a complaint or by calling 1-800-985-3059 (toll-free).

STATE AGENCY CONTACT INFORMATION:

South Carolina Department of Insurance

Office of Consumer Services

PHONE: 1-803-737-6180

WEBSITE: https://www.doi.sc.gov/1001/No-Surprises-Act-Information

ADDITIONAL INFORMATION:

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

FILING A COMPLAINT:

You may file a complaint with the federal government through the U.S. Department of Health and Human Services at https://www.cms.gov/nosurprises/consumers or by calling 1-800-985-3059.

STATE AGENCY CONTACT INFORMATION:

South Dakota Division of Insurance

PHONE: 1-605-773-3563

WEBSITE: https://dlr.sd.gov/insurance/no_surprises_act.aspx

ADDITIONAL INFORMATION:

Consumers who have questions regarding the No Surprises Act or believe they have received a surprise bill can contact the South Dakota Division of Insurance.

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

FILING A COMPLAINT:

If Tennessee consumers should experience a surprise bill, they should file a complaint with the Tennessee Department of Commerce & Insurance team. To file a complaint, consumers should visit TDCI’s website at https://www.tn.gov/commerce/insurance/consumer-resources.html or call TDCI’s Consumer Insurance Services team at 1-800-342-4029 or 1-615-741-2218.

File a complaint with the federal government at  https://www.cms.gov/nosurprises/consumers  or by calling 1-800-985-3059.

STATE AGENCY CONTACT INFORMATION:

Tennessee Department of Commerce & Insurance

PHONE: 1-800-342-4029 or 1-615-741-2218

WEBSITE: https://www.tn.gov/commerce/insurance/consumer-resources.html

ADDITIONAL INFORMATION:

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

ADDITIONAL STATE-LAW PROTECTIONS FOR PATIENTS WITH STATE-REGULATED HEALTH PLANS AND OTHER CERTAIN PLANS:

• The Texas law protects certain covered patients from surprise medical bills in emergencies, when they didn’t have a choice of doctors, or when they receive emergency ground ambulance services. The law bans doctors and providers from sending surprise medical bills to patients in those cases. It does not apply to air ambulance services.
  • State law authorizes arbitration (for doctors) and mediation (for facilities) to resolve payment disputes in those cases.
  • The law carves out a narrow exception when a consumer chooses an out-of-network doctor or provider at an in-network facility. See the Balance billing waiver at https://www.tdi.texas.gov/medical-billing/providers.html#waiver.

• Texas’s surprise billing laws apply to state-regulated health insurance regulated by the Texas Department of Insurance. How can you tell if a plan is regulated by TDI? 
  • The patient’s insurance card will have TDI or DOI on it. See examples at https://www.tdi.texas.gov/consumer/insurance-card-examples.html.
  • The patient is insured through the Employees Retirement System of Texas (ERS): HealthSelect at https://ers.texas.gov/active-employees/health-benefits and other ERS plans at https://ers.texas.gov/Active-Employees/Health-Benefits/HMOs.
  • The patient is insured through the Teacher Retirement System of Texas (TRS): TRS ActiveCare at https://www.trs.texas.gov/Pages/healthcare_trs_activecare.aspx and TRS-Care Standard for non-Medicare retirees at https://www.trs.texas.gov/Pages/healthcare_trs_care.aspx.

• Texas law also permits self-insured and self-funded plans to elect to participate in Texas’ state-level surprise billing law.

ADDITIONAL STATE GUIDANCE:

• If you have questions about your bill, call the doctor or provider who billed you. If they have questions, they should call your health plan.

FILING A COMPLAINT:

• If you want to file a complaint about a doctor: Go to the Texas Medical Board website at https://www.tmb.state.tx.us/page/place-a-complaint. You also can use the Texas Medical Board website to file a complaint about physician assistants, acupuncturists, surgical assistants, respiratory care practitioners, medical radiologic technologists, medical physicist, and perfusionists.
• If you want to file a complaint about a hospital or facility: Contact Texas Health and Human Services at https://www.hhs.texas.gov/about/contact-us.
• If you want to file a complaint about your health plan or insurance company: Go to the Texas Department of Insurance’s “Get help with an insurance complaint” webpage at https://www.tdi.texas.gov/consumer/get-help-with-an-insurance-complaint.html.

STATE AGENCY CONTACT INFORMATION:

Texas Department of Insurance

PHONE: 1-800-252-3439

WEBSITE: https://www.tdi.texas.gov/medical-billing/smbm-20.html

ADDITIONAL INFORMATION:

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

FILING A COMPLAINT:

If you believe you’ve been wrongly billed by a health care provider, You may file a complaint with the federal government through the U.S. Department of Health and Human Services at https://www.cms.gov/nosurprises/consumers/complaints-about-medical-billingor by calling 1-800-985-3059. You may also contact the Utah Insurance Department via email at health.uid@utah.gov or by calling 1-800-439-3805 or 1-801-957-9280.

STATE AGENCY CONTACT INFORMATION:

Utah Insurance Department

PHONE: 1-800-439-3805

WEBSITE: https://insurance.utah.gov/consumer/health/no-surprises-act

ADDITIONAL INFORMATION:

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

FILING A COMPLAINT:

You may file a complaint with the federal government through the U.S. Department of Health and Human Services at https://www.cms.gov/nosurprises/consumers or by calling 1-800-985-3059.

STATE AGENCY CONTACT INFORMATION:

Vermont Department of Financial Regulation

PHONE: 1-802-828-3302

WEBSITE: https://dfr.vermont.gov/no-surprises-act

ADDITIONAL INFORMATION:

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

ADDITIONAL STATE-LAW PROTECTIONS FOR PATIENTS WITH STATE-REGULATED HEALTH PLANS AND CERTAIN OTHER PLANS:

• Insurers are required to tell you which providers and facilities are in their networks. Providers and facilities must tell you with which provider networks they participate. This information is on the insurer’s, provider’s or facility’s website or on request.
• When you get services from an in-network facility, certain providers there may be out-of- network. In these cases, the most those providers can bill you is your plan’s in-network cost- sharing amount. This applies to emergency medicine, laboratory, surgeon  and  assistant surgeon  services,  and professional ancillary services such as anesthesia, pathology, radiology, neonatology, hospitalist, or intensivist services. These providers can’t balance  bill  you  and  can’t  ask  you  to  give  up your protections not to be balance billed.
• Consumers covered under (i) a fully-insured policy issued in Virginia, (ii) the Virginia state employee health benefit plan; or (iii) a self-funded group that opted-in to the Virginia protections are also protected from balance  billing  under  Virginia  law. 
• Virginia’s balance billing restrictions for “emergency services" also includes the following as related to any mental health services or substance abuse services (as defined under state law) rendered at a behavioral health crisis service provider:
  • a behavioral health assessment that is within the capability of a behavioral health crisis service provider, including ancillary services routinely available to evaluate such emergency medical condition, and
  • further examination and treatment, within the capabilities of the staff and facilities available at the behavioral health crisis service provider, as required so that the patient's condition does not deteriorate.

FILING A COMPLAINT:

If you think you’ve been  wrongly  billed, You may file a complaint with the federal government through the U.S. Department of Health and Human Services at https://www.cms.gov/nosurprises/consumers or by calling 1-800-985-3059 and/or file a complaint with the Virginia State Corporation Commission Bureau of Insurance at: scc.virginia.gov/pages/File-Complaint- Consumers or call 1-877-310-6560.

STATE AGENCY CONTACT INFORMATION:

Virginia State Corporation Commission Bureau of Insurance

PHONE: 1-800-985-3059

WEBSITE: https://scc.virginia.gov/pages/Balance-Billing-Protection

ADDITIONAL INFORMATION:

Visit https://scc.virginia.gov/pages/balance-billing-protection for more information about your rights under Virginia law.

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

ADDITIONAL STATE-LAW PROTECTIONS FOR PATIENTS WITH STATE-REGULATED HEALTH PLANS:

• Washington law allows self-funded group health plans to opt-in to Washington’s Balance Billing Protection Act.
• Insurers are required to tell you, via their websites or on request, which providers, hospitals, and facilities are in their networks. Hospitals, surgical facilities, and providers must tell you which provider networks they participate in on their website or on request.
• If you have an emergency medical condition, mental health or substance use disorder 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 care you receive in a hospital and in facilities that provide crisis services to people experiencing a mental health or substance use disorder emergency. You can't be balance billed for these emergency services, including services you may get after you're in stable condition.
• Washington law SSB 5986 also bans balance billing for “ground ambulance services,” which is defined to include:
  • The medical treatment and care rendered at the scene of a medical emergency or while transporting a patient from the scene to an appropriate health care facility or behavioral health emergency services provider when the services are provided by one or more ground ambulance vehicles designed for this purpose; and
  • Ground ambulance transport between hospitals or behavioral health emergency services providers, hospitals or behavioral health emergency services providers, and other health care facilities or locations, and between health care facilities when the services are medically necessary and are provided by one or more ground ambulance vehicles designed for this purpose.
• Health care providers, including hospitals and air ambulance providers, can never require you to give up your protections from balance billing. If you have coverage through a self-funded group health plan, in some limited situations, a provider can ask you to consent to waive your balance billing protections, but you are never required to give your consent. Please contact your employer or health plan for more information.

FILING A COMPLAINT:

If you believe you've been wrongly billed, You may file a complaint with the federal government through the U.S. Department of Health and Human Services at https://www.cms.gov/nosurprises/consumers or by calling 1-800-985-3059; and/or file a complaint with the Washington State Office of the Insurance Commissioner at https://www.insurance.wa.gov/file-complaint-or-check-your-complaint-status or by calling 1 -800-562- 6900.

STATE AGENCY CONTACT INFORMATION:

Washington State Office of the Insurance Commissioner

PHONE: 1 -800-985-3059

WEBSITE: https://www.insurance.wa.gov/protections-surprise-medical-billing

ADDITIONAL INFORMATION:

Visit the Office of the Insurance Commissioner Balance Billing Protection Act website at https://www.insurance.wa.gov/protections-surprise-medical-billing for more information about your rights under Washington state law.

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

ADDITIONAL STATE GUIDANCE:

You may reach out to the West Virginia Offices of the Insurance Commissioner’s Consumer Services Division at 1-888-TRY-WVIC (1-888-879-9842) or OICConsumerServices@wv.gov for assistance with surprise medical bills or other questions concerning the No Surprises Act (NSA). You may also visit their website at www.wvinsurance.gov/no_surprises_act.

FILING A COMPLAINT:

File a complaint with the federal government at  https://www.cms.gov/nosurprises/consumers  or by calling 1-800-985-3059.

STATE AGENCY CONTACT INFORMATION:

West Virginia Offices of the Insurance Commissioner

PHONE: 1-888-879-9842

WEBSITE: https://www.wvinsurance.gov/no_surprises_act

ADDITIONAL INFORMATION:

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

FILING A COMPLAINT:

If you've received a surprise bill that you think isn't allowed under the No Surprises Act, you can file an appeal with your insurance company or ask for an external review of the company's decision. You also can file a complaint with the Wisconsin Office of the Commissioner of Insurance at https://oci.wi.gov/Pages/Consumers/Types-of-Complaints.aspx or the federal Department of Health and Human Services at https://www.cms.gov/medical-bill-rights.

STATE AGENCY CONTACT INFORMATION:

Wisconsin Office of the Commissioner of Insurance

PHONE: 1-800-236-8517 (outside of Wisconsin) or 1-608-266-0103 (within Wisconsin)

WEBSITE: oci.wi.gov/Complaints

ADDITIONAL INFORMATION:

Learn more about Protections from Surprise Medical Bills at https://oci.wi.gov/Pages/Consumers/PI-328.aspx​.

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.

FILING A COMPLAINT:

You may file a complaint with the federal government through the U.S. Department of Health and Human Services at https://www.cms.gov/nosurprises/consumers or by calling 1-800-985-3059.

ADDITIONAL INFORMATION:

Visit https://www.cms.gov/nosurprises/consumers or call 1-800-985-3059 for more information about your rights under federal law.