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No Surprises Act and Good Faith Estimates
Your rights & protections against surprise medical bills
When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn't be charged more than your plan's copayments, coinsurance and/or deductible.
UI Health does NOT balance bill.
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, like a copayment, coinsurance, or deductible. You may have additional 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" means providers and facilities that haven't signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays 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 plan's deductible or annual out-of-pocket limit.
You're protected from balance billing for:
If you receive emergency services for an emergency medical condition and UI Health is out-of-network, the most you will be billed for is your plan's in-network cost-sharing amount (such as copayments, coinsurance, and deductibles).
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. The most those providers can 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. At UI Health, our providers are in-network with plans accepted by the hospital. You will not be balance billed and you will not be asked to give up your protections not to be balanced billed.
You are not required to get out-of-network care. You can choose a provider or facility in your plan's network.
When balance billing isn't allowed, you also have these protections:
- You're only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.
- Generally, your health plan must:
- Cover emergency services without requiring you to get approval for services in advance (also known as "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 in-network deductible and out-of-pocket limit.
If you believe you've been wrongly billed, please contact UI Health's billing department by calling 312.996.1000 or email@example.com to resolve your questions and concerns as quickly as possible. You may contact the Illinois Attorney General Health Care Bureau by visiting: illinoisattorneygeneral.gov/consumers/healthcare.html or calling toll free 1.877.305.5145 (TTY 1.800-964.3013).
Visit cms.gov/nosurprises/consumers for more information about your rights under federal law.
You have the right to receive a "good faith estimate" explaining how much your medical care will cost
Under the law, health care providers need to give patients who don't have insurance or who are not using insurance an estimate of the bill for non-emergent medical items and services that are scheduled 3 or more days in advance of the service.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests and hospital fees.
Make sure UI Health provides you with a Good Faith Estimate in writing before your scheduled medical services or item. For certain types of services, a clinical evaluation may be required to provide you with an accurate Good Faith Estimate. If a provider wants to proceed with additional clinical testing, you may be presented with a new Good Faith Estimate. You can ask our scheduling or front desk staff for a Good Faith Estimate before you schedule an item or service.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill initially by contacting UI Health's billing department.
Make sure to save a copy or picture of your Good Faith Estimate.
For questions or issues around your bill and estimate please contact UI Health's billing department at 312.996.1000 or emailing firstname.lastname@example.org. For more information about your rights to a Good Faith Estimate, visit cms.gov/nosurprises or call 1.800.985.3059.