{"id":19138,"date":"2022-01-04T09:45:43","date_gmt":"2022-01-04T14:45:43","guid":{"rendered":"https:\/\/mysouthwell.com\/?page_id=19138"},"modified":"2026-03-11T08:14:48","modified_gmt":"2026-03-11T12:14:48","slug":"surprise-medical-billing-rights-and-protections","status":"publish","type":"page","link":"https:\/\/mysouthwell.com\/surprise-medical-billing-rights-and-protections\/","title":{"rendered":"Surprise Medical Billing Rights and Protections"},"content":{"rendered":"\t\t
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Home<\/a> \/ Patient & Visitors<\/a> \/ Surprise Medical Billing Rights and Protections<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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Your Rights and Protections Against Surprise Medical Bills<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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What is “balance billing” (sometimes called “surprise billing”)?<\/h3>

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and\/or a 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\u2019t in your health plan\u2019s network.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\"Out-of-network\"\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t

\n\t\t\t\t\t\tDescribes providers and facilities that haven\u2019t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called \u201cbalance billing.\u201d This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.\t\t\t\t\t<\/p>\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\"Surprise Billing\"\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t

\n\t\t\t\t\t\tSurprise Billing is an unexpected balance bill. This can happen when you can\u2019t control who is involved in your care\u2014like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.\t\t\t\t\t<\/p>\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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You are protected from balance billing for:<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Emergency Services <\/div><\/span>\n\t\t\t\t\t\t\t\n\t\t\t<\/i><\/span>\n\t\t\t<\/i><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t
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If you have an emergency medical 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\u2019s in-network cost-sharing amount (such as copayments and coinsurance). You can\u2019t <\/strong>be balance billed for these emergency services. This includes services you may get after you\u2019re in stable condition unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.<\/p>

The state of Georgia and the federal government both have laws to protect you from balance billing although they are a little different. State rules only apply to fully insured commercial health insurance plans and some government plans. Federal rules may also apply to commercial health insurance in situations where you received health care services in another state, your health insurance is regulated by a state other than Georgia or the health care service you received is not regulated by the state law.\u00a0 Most of the differences between the state and federal laws are in the way the rules affect providers and health insurers, so you usually won\u2019t need to worry about that. However, the grievance processes are different, as indicated on the government websites linked below.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t

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Certain services at an in-network hospital, ambulatory surgical center or other facilities <\/div><\/span>\n\t\t\t\t\t\t\t\n\t\t\t<\/i><\/span>\n\t\t\t<\/i><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t
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When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan\u2019s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can\u2019t <\/strong>balance bill you and may not <\/strong>ask you to give up your protections not to be balance billed. Under Georgia law this rule also applies to imaging centers, birthing centers, and similar facilities in addition to hospitals and ambulatory surgical centers. If you get other services at these in-network facilities, out-of-network providers can\u2019t <\/strong>balance bill you, unless you give written consent and give up your protections.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t\t

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You\u2019re never<\/u> required to give up your protection from balance billing. You also aren\u2019t required to get care out-of-network. You can choose a provider or facility in your plan\u2019s network. <\/div><\/span>\n\t\t\t\t\t\t\t\n\t\t\t<\/i><\/span>\n\t\t\t<\/i><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t\t<\/summary>\n\t\t\t\t
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The best way to find an in-network provider is to use the online provider directory on your health plan\u2019s website.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/details>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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When balance billing isn\u2019t allowed, you also have the following protections:<\/h3>