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Galaxy Behavioral Health

No Surprises Act

YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLS

(No Surprises Act)

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.

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, 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’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 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 “balance billing.”

You are protected from balance billing for:

  • Emergency services: 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’s in-network cost-sharing amount.
  • 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. In these cases, those providers cannot balance bill you.

Good Faith Estimate

If you are uninsured or not using insurance to pay for your care, you have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care will cost.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services.
  • Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item.
  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

For more information about your rights under federal law, visit www.cms.gov/nosurprises or call 1-800-985-3059.