No Surprises Act

Your Rights and Protections Against Surprise Medical Bills

Cait Helton, LMFT

Virtual Therapy in Charlotte, NC

When you receive care, you are protected from surprise billing or balance billing in certain circumstances under the No Surprises Act.

What Is Balance Billing (Surprise Billing)?

When you see a health care provider, you may owe out-of-pocket costs like copayments, coinsurance, or deductibles. However, if you visit a provider or facility that is not in your health plan’s network (out-of-network), you may be billed for the difference between what your plan covers and what the provider charges. This is called “balance billing.”

Surprise billing occurs when you unexpectedly receive services from an out-of-network provider, such as during an emergency or at an in-network facility where you didn’t know the provider was out-of-network.

Protections Against Surprise Billing

You are protected from balance billing for:

1. Emergency Services:

• If you receive emergency care from an out-of-network provider or facility, they can only bill you for your plan’s in-network cost-sharing amount (e.g., copayments or coinsurance).

• This includes services you may receive after you’re stabilized, unless you give written consent to waive your protections.

2. Certain Services at In-Network Facilities:

• For services like anesthesia, pathology, radiology, or laboratory work at an in-network facility, out-of-network providers cannot bill you more than your in-network cost-sharing amount.

• You cannot be asked to waive these protections except under specific conditions.

Additional Protections

When balance billing is prohibited, you are entitled to:

• Pay only your in-network share of the cost, such as copayments or deductibles.

• Have your health plan cover emergency services without prior authorization.

• Have any payments count toward your in-network deductible and out-of-pocket maximums.

What to Do If You’re Wrongly Billed

If you believe you have been wrongly billed:

• Contact the North Carolina Department of Insurance at 1-855-408-1212.

• You may also contact the Centers for Medicare & Medicaid Services (CMS) at 1-800-985-3059 or TTY: 1-800-985-3059.

For additional information, please visit North Carolina’s Department of Insurance website or call the number above.

This policy ensures compliance with federal law and reflects my commitment to providing clear, transparent billing practices.