Reference Based Pricing

  • Balance/Surprise Billing
    • Occurs when out-of-network providers bill you for the difference between what your plan pays and the full amount charged for a service. This bill is usually higher than in-network services. May not count toward your maximum out-of-pocket
  • Your Rights and Protections Against Surprise/Balance Billing
    • Emergency Services
      • You cannot be balance billed for emergency services. Providers/facilities can only bill your in-network cost-sharing (co-insurance/co-payment).
    • Services at an In-Network Hospital or Ambulatory Surgery Center
      • Some providers at these facilities may be out-of-network. The most they may bill you is your plan’s in-network cost-sharing amount.
      • They cannot balance bill you unless you provide written consent giving up these protections.
      • You are never required to give up your protections.
  • The above information is for educational purposes only and does not have the force of law.
  • If you believe you were wrongly billed: