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BILLING DISCLOSURE

Your Rights and Protections Against Surprise Medical Bills

Effective Date: [PENDING — set on publish]
Draft prepared for Dr. Gregory G. Yu’s review. Will not be published until reviewed and approved by Arlington ER’s legal/compliance advisor.

Your Rights and Protections Against Surprise Medical Bills

When you get emergency care, you are protected from surprise billing or balance billing under the No Surprises Act. This federal law protects patients from unexpected medical bills that arise when treated by an out-of-network provider, which can happen even at an in-network facility during an emergency.

What Is Balance Billing?

When you see a doctor or other healthcare provider, you may owe certain out-of-pocket costs, such as 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 healthcare 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. 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.” This amount is likely more than in-network costs 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 get emergency services from an out-of-network provider or facility, the most they can bill you is your plan's in-network cost-sharing amount, such as copayments and coinsurance.
  • Certain services at an in-network hospital or ambulatory surgical center. When you get emergency care or are treated by an out-of-network provider at an in-network facility, you are only responsible for paying your in-network cost-sharing amount.

In these cases, you cannot be balance billed, and this amount may not count toward your annual out-of-pocket limit.

When Balance Billing Isn't Allowed, You Also Have the Following Protections:

  • You are only responsible for paying your share of the cost, such as the copayments, coinsurance, and deductibles you would pay if the provider or facility were in-network. Your health plan will pay any additional amounts owed to out-of-network providers and facilities directly.
  • Generally, your health plan must count any amount you pay for emergency services toward your in-network deductible and out-of-pocket limit.
  • Your health plan cannot require you to get prior authorization (approval in advance) for emergency services.

If You Believe You've Been Wrongly Billed

If you think you’ve been wrongly billed, you may contact the U.S. Centers for Medicare & Medicaid Services (CMS) Help Desk at 1-800-985-3059, or visit cms.gov/nosurprises for more information about your rights under federal law. You can also contact our Patient Billing Advocates directly, and we will review your bill and Explanation of Benefits with you line by line.

Estimate of Charges

Because emergency conditions and the treatment they require vary from patient to patient, we cannot provide a fixed price quote in advance of your visit. Our standard charges for common services are listed in our Chargemaster, available below. Once you’ve been evaluated, our Patient Billing Advocates can walk you through your expected costs based on your specific diagnosis and insurance coverage.

View Chargemaster

Contact Information

If you have questions about a bill or believe you have been wrongly billed, contact our Patient Billing Advocates:

Arlington ER
1607 S Bowen Rd, Pantego, TX 76013
Phone: 817-973-7406
Email: billing@arlingtoner.com

Visit cms.gov/nosurprises for more information about your rights under federal law.