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 (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
CO, FL, GA, IL, MI, NV, OH and TX have state laws that prohibit certain surprise medical bills when you see an out-of-network provider. If you had emergency services from an out-of-network provider you are protected under the federal law, and may also be protected under a state law. You can visit the following state websites to gain additional information on your protections under state law:
Certain non-emergency 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, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.
You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.
CO, FL, GA, MI, OH, and TX have state laws that prohibit certain surprise medical bills when you see an out-of-network provider. If you had non-emergent services from an out-of-network provider at an in-network facility you are protected under the federal law, and may also be protected under a state law. You can visit the following state websites to gain additional information on your protections under state law:
For Colorado residents
If you believe you've been wrongly billed, please contact your insurance company at the number on your ID card.
You can also contact the Colorado Division of Insurance at:
For reimbursement information, see these details about out-of-network health care provider reimbursements.
Ambulance Information: Balance billing claims related to services provided by air ambulances are governed by federal law. Services provided by ground ambulances are regulated by Colorado state law and do not allow private companies to balance bill. However, you may be balance billed for emergency services you receive if the ambulance service provider is a publicly funded fire agency or if the ambulance services are for a non-emergency, such as ambulance transport between hospitals, that is not a post-stabilization service.