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No Surprises Act notice

Your rights and protections against surprise medical bills

Required posting under the federal No Surprises Act

What is “balance billing” (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, or 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 allowed 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 to be more than the in-network cost for the same service and might not count toward your annual out-of-pocket limit.

You are protected from balance billing for:

  • Emergency services
    If you have an emergency medical condition and receive emergency services from an out-of-network provider or facility, the most you can be billed is your plan’s in-network cost-sharing amount. You cannot be balance billed for these emergency services, including services you receive after your condition is stable, unless you give written consent to waive your protections.
  • Certain services at an in-network hospital or ambulatory surgical center
    When you receive services at an in-network hospital or ambulatory surgical center, some providers involved in your care 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 includes services such as emergency medicine, anesthesia, pathology, radiology, and services provided by hospitalists, intensivists, and assistant surgeons. These providers cannot balance bill you or ask you to waive your protections.

When balance billing is not allowed, you also have these protections:

  • You are only responsible for paying your share of the cost, including copayments, coinsurance, and deductibles that you would pay if the provider or facility were in network. These amounts are paid directly to your health plan.
  • Your health plan generally must pay out-of-network providers and facilities directly.
  • Your health plan generally must count any amount you pay toward your deductible and out-of-pocket limit as if it were an in-network payment.

Colorado state protections

In addition to the federal No Surprises Act, Colorado’s out-of-network law (C.R.S. § 10-16-704, enacted by HB19-1174) provides similar protections for Colorado-regulated health plans. It also includes a state process for resolving payment disputes between insurers and out-of-network providers, so you are not caught in the middle.

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