The No Surprises Act. Your Rights and Protections Against Surprise Medical Bills.
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 also may have other costs or have to pay the entire bill if you receive care from a provider that is “out-of-network” for your health plan’s network.
“Out-of-network” means the provider has not signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan agreed to pay and the full amount charged to the plan for a service. This is called “balance billing.” This amount may be more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like 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 that you do not or cannot choose.
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 typically 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 at the facility caring for you after you’re in stable condition.
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, 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 certain 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.
Effect of Specific State Rules
Some states have their own laws relating to balance or surprise billing for out-of-network laboratory or pathology services that may be different from those described here, including the states listed below. The links below contain state specific balance billing information and resources, including contact information for state agencies that may be able to help you.
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.
When balance billing isn’t allowed, you also have these protections:
You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles) that you would pay if Verici Dx was an in-network provider. Your health plan will pay Verici Dx directly.
Your health plan generally must:
Cover emergency services without requiring you to get approval for services in advance (prior authorization).
Cover emergency services by out-of-network providers.
Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.
If you think you’ve been wrongly billed: you may file a complaint with the federal government at https://www.cms.gov/nosurprises/consumers or by calling 1-800-985-3059; and/or file a complaint with your state balance billing regulator, if any, which is identified in the state-specific tabs.
Visit https://www.cms.gov/nosurprises for more information about your rights under federal law or visit your home state regulator’s website (included in state links above) for more information about your state balance billing rights.
Arizona Residents
ARIZONA LAW MAY PROVIDE PROTECTIONS TO YOU AND ALLOW VERICI DX TO BILL YOU FOR AMOUNTS THAT ARE DIFFERENT FROM THOSE PROVIDED BY THE FEDERAL LAW AS DESCRIBED IN YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLING.
FOR MORE INFORMATION REGARDING YOUR PROTECTIONS AGAINST SURPRISE BILLING, CONTACT OR VISIT:
Arizona Department of Insurance and Financial Institutions Address: 100 N. 15th Ave. Ste. 261, Phoenix, AZ 85007-2630
CALIFORNIA LAW MAY PROVIDE PROTECTIONS TO YOU AND ALLOW VERICI DX TO BILL YOU FOR AMOUNTS THAT ARE DIFFERENT FROM THOSE PROVIDED BY THE FEDERAL LAW AS DESCRIBED IN YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLING.
FOR MORE INFORMATION REGARDING YOUR PROTECTIONS AGAINST SURPRISE BILLING OR TO LEARN ABOUT MAKING A COMPLAINT CONTACT OR VISIT:
COLORADO LAW MAY PROVIDE PROTECTIONS TO YOU AND ALLOW VERICI DX TO BILL YOU FOR AMOUNTS THAT ARE DIFFERENT FROM THOSE PROVIDED BY THE FEDERAL LAW AS DESCRIBED IN YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLING.
FOR MORE INFORMATION REGARDING YOUR PROTECTIONS AGAINST SURPRISE BILLING OR TO LEARN ABOUT MAKING A COMPLAINT CONTACT OR VISIT: Office of the Attorney General
Address: 1300 Broadway, 10th Floor, Denver, CO 80203
CONNECTICUT LAW MAY PROVIDE PROTECTIONS TO YOU AND ALLOW VERICI DX TO BILL YOU FOR AMOUNTS THAT ARE DIFFERENT FROM THOSE PROVIDED BY THE FEDERAL LAW AS DESCRIBED IN YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLING.
FOR MORE INFORMATION REGARDING YOUR PROTECTIONS AGAINST SURPRISE BILLING OR TO LEARN ABOUT MAKING A COMPLAINT CONTACT OR VISIT:
The State of Connecticut does not have a state balance billing enforcement program or maintain publicly available information about its balance billing laws.
DELAWARE LAW MAY PROVIDE PROTECTIONS TO YOU AND ALLOW VERICI DX TO BILL YOU FOR AMOUNTS THAT ARE DIFFERENT FROM THOSE PROVIDED BY THE FEDERAL LAW AS DESCRIBED IN YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLING.
FOR MORE INFORMATION REGARDING YOUR PROTECTIONS AGAINST SURPRISE BILLING OR TO LEARN ABOUT MAKING A COMPLAINT CONTACT OR VISIT:
Delaware Department of Insurance
Phone: 1-800-282-8611 (In Delaware Only) Or (302) 674-7310
FLORIDA LAW MAY PROVIDE PROTECTIONS TO YOU AND ALLOW VERICI DX TO BILL YOU FOR AMOUNTS THAT ARE DIFFERENT FROM THOSE PROVIDED BY THE FEDERAL LAW AS DESCRIBED IN YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLING (HYPERLINK BACK TO THE GENERAL NSA BILLING RIGHTS IN THE EVENT A FL RESIDENT LANDS HERE.).
FOR MORE INFORMATION REGARDING YOUR PROTECTIONS AGAINST SURPRISE BILLING OR TO LEARN ABOUT MAKING A COMPLAINT CONTACT OR VISIT:
Florida has not designated a surprise billing enforcement agency.
GEORGIA LAW MAY PROVIDE PROTECTIONS TO YOU AND ALLOW VERICI DX TO BILL YOU FOR AMOUNTS THAT ARE DIFFERENT FROM THOSE PROVIDED BY THE FEDERAL LAW AS DESCRIBED IN YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLING.
FOR MORE INFORMATION REGARDING YOUR PROTECTIONS AGAINST SURPRISE BILLING OR TO LEARN ABOUT MAKING A COMPLAINT CONTACT OR VISIT:
Office of Commissioner of Insurance
Address: 2 Martin Luther King Jr. Dr., West Tower, Suite 702, Atlanta, GA 30334
ILLINOIS LAW MAY PROVIDE PROTECTIONS TO YOU AND ALLOW VERICI DX TO BILL YOU FOR AMOUNTS THAT ARE DIFFERENT FROM THOSE PROVIDED BY THE FEDERAL LAW AS DESCRIBED IN YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLING.
FOR MORE INFORMATION REGARDING YOUR PROTECTIONS AGAINST SURPRISE BILLING OR TO LEARN ABOUT MAKING A COMPLAINT CONTACT OR VISIT:
INDIANA LAW MAY PROVIDE PROTECTIONS TO YOU AND ALLOW VERICI DX TO BILL YOU FOR AMOUNTS THAT ARE DIFFERENT FROM THOSE PROVIDED BY THE FEDERAL LAW AS DESCRIBED IN YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLING.
FOR MORE INFORMATION REGARDING YOUR PROTECTIONS AGAINST SURPRISE BILLING OR TO LEARN ABOUT MAKING A COMPLAINT CONTACT OR VISIT:
Indiana Department of Insurance, Consumer Service Department.
Address: 311 West Washington Street, Suite 300, Indianapolis, IN 46204-2787
Telephone: 1-800-622-4461
MAINE LAW MAY PROVIDE PROTECTIONS TO YOU AND ALLOW VERICI DX TO BILL YOU FOR AMOUNTS THAT ARE DIFFERENT FROM THOSE PROVIDED BY THE FEDERAL LAW AS DESCRIBED IN YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLING.
FOR MORE INFORMATION REGARDING YOUR PROTECTIONS AGAINST SURPRISE BILLING OR TO LEARN ABOUT MAKING A COMPLAINT CONTACT OR VISIT:
Maine Bureau of Insurance
Address: 34 State House Station, Augusta, ME 04333
MARYLAND LAW MAY PROVIDE PROTECTIONS TO YOU AND ALLOW VERICI DX TO BILL YOU FOR AMOUNTS THAT ARE DIFFERENT FROM THOSE PROVIDED BY THE FEDERAL LAW AS DESCRIBED IN YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLING.
FOR MORE INFORMATION REGARDING YOUR PROTECTIONS AGAINST SURPRISE BILLING OR TO LEARN ABOUT MAKING A COMPLAINT CONTACT OR VISIT:
The Maryland Insurance Administration
Address: 200 St. Paul Place, Suite 2700, Baltimore, Maryland 21202
MASSACHUSETTS LAW MAY PROVIDE PROTECTIONS TO YOU AND ALLOW VERICI DX TO BILL YOU FOR AMOUNTS THAT ARE DIFFERENT FROM THOSE PROVIDED BY THE FEDERAL LAW AS DESCRIBED IN YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLING.
FOR MORE INFORMATION REGARDING YOUR PROTECTIONS AGAINST SURPRISE BILLING OR TO LEARN ABOUT MAKING A COMPLAINT CONTACT OR VISIT:
Health and Human Services of the Commonwealth of Massachusetts
MICHIGAN LAW MAY PROVIDE PROTECTIONS TO YOU AND ALLOW VERICI DX TO BILL YOU FOR AMOUNTS THAT ARE DIFFERENT FROM THOSE PROVIDED BY THE FEDERAL LAW AS DESCRIBED IN YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLING.
FOR MORE INFORMATION REGARDING YOUR PROTECTIONS AGAINST SURPRISE BILLING OR TO LEARN ABOUT MAKING A COMPLAINT CONTACT OR VISIT:
Michigan Department of Insurance and Financial Services
MISSISSIPPI LAW MAY PROVIDE PROTECTIONS TO YOU AND ALLOW VERICI DX TO BILL YOU FOR AMOUNTS THAT ARE DIFFERENT FROM THOSE PROVIDED BY THE FEDERAL LAW AS DESCRIBED IN YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLING.
FOR MORE INFORMATION REGARDING YOUR PROTECTIONS AGAINST SURPRISE BILLING OR TO LEARN ABOUT MAKING A COMPLAINT CONTACT OR VISIT:
Mississippi Insurance Department, Office of the Insurance Commissioner
Address: Mississippi Insurance Department, P.O. Box 79, Jackson, MS 39205
MISSOURI LAW MAY PROVIDE PROTECTIONS TO YOU AND ALLOW VERICI DX TO BILL YOU FOR AMOUNTS THAT ARE DIFFERENT FROM THOSE PROVIDED BY THE FEDERAL LAW AS DESCRIBED IN YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLING.
FOR MORE INFORMATION REGARDING YOUR PROTECTIONS AGAINST SURPRISE BILLING OR TO LEARN ABOUT MAKING A COMPLAINT CONTACT OR VISIT:
Missouri Department of Insurance Address: PO Box 690, Jefferson City, MO 65102-0690
NEBRASKA LAW MAY PROVIDE PROTECTIONS TO YOU AND ALLOW VERICI DX TO BILL YOU FOR AMOUNTS THAT ARE DIFFERENT FROM THOSE PROVIDED BY THE FEDERAL LAW AS DESCRIBED IN YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLING.
FOR MORE INFORMATION REGARDING YOUR PROTECTIONS AGAINST SURPRISE BILLING OR TO LEARN ABOUT MAKING A COMPLAINT CONTACT OR VISIT:
Nebraska Department of Insurance
Phone: 402-471-2201 or call our toll-free consumer hotline at 1-877-564-7323.
Additional information is available on our website at.
NEVADA LAW MAY PROVIDE PROTECTIONS TO YOU AND ALLOW VERICI DX TO BILL YOU FOR AMOUNTS THAT ARE DIFFERENT FROM THOSE PROVIDED BY THE FEDERAL LAW AS DESCRIBED IN YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLING.
FOR MORE INFORMATION REGARDING YOUR PROTECTIONS AGAINST SURPRISE BILLING OR TO LEARN ABOUT MAKING A COMPLAINT CONTACT OR VISIT:
Nevada Department of Insurance Consumer Compliance & Licensing 1818 E. College Pkwy., Suite 103 Carson City, NV 89706
NEW HAMPSHIRE LAW MAY PROVIDE PROTECTIONS TO YOU AND ALLOW VERICI DX TO BILL YOU FOR AMOUNTS THAT ARE DIFFERENT FROM THOSE PROVIDED BY THE FEDERAL LAW AS DESCRIBED IN YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLING.
FOR MORE INFORMATION REGARDING YOUR PROTECTIONS AGAINST SURPRISE BILLING OR TO LEARN ABOUT MAKING A COMPLAINT CONTACT OR VISIT:
New Hampshire Insurance Department
Address: 21 South Fruit Street, Suite 14, Concord, NH 03301
NEW JERSEY LAW MAY PROVIDE PROTECTIONS TO YOU AND ALLOW VERICI DX TO BILL YOU FOR AMOUNTS THAT ARE DIFFERENT FROM THOSE PROVIDED BY THE FEDERAL LAW AS DESCRIBED IN YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLING.
FOR MORE INFORMATION REGARDING YOUR PROTECTIONS AGAINST SURPRISE BILLING OR TO LEARN ABOUT MAKING A COMPLAINT CONTACT OR VISIT:
New Jersey Department of Banking and Insurance
Address: State of 20 West State Street P.O. Box 325 Trenton, New Jersey 08625-0325
NEW MEXICO LAW MAY PROVIDE PROTECTIONS TO YOU AND ALLOW VERICI DX TO BILL YOU FOR AMOUNTS THAT ARE DIFFERENT FROM THOSE PROVIDED BY THE FEDERAL LAW AS DESCRIBED IN YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLING.
FOR MORE INFORMATION REGARDING YOUR PROTECTIONS AGAINST SURPRISE BILLING OR TO LEARN ABOUT MAKING A COMPLAINT CONTACT OR VISIT:
For patients in New York, if your insurance ID card says, “fully insured coverage,” surprise bills include when you’re in-network doctor refers you to an out-of-network provider without your consent (including lab and pathology services). These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed. You may need to sign a form (available on the Department of Financial Services’ website) for the full balance billing protection to apply.
These rights and protections are different from those described in YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLING
FOR MORE INFORMATION REGARDING YOUR PROTECTIONS AGAINST SURPRISE BILLING OR TO LEARN ABOUT MAKING A COMPLAINT CONTACT OR VISIT:
OHIO LAW MAY PROVIDE PROTECTIONS TO YOU AND ALLOW VERICI DX TO BILL YOU FOR AMOUNTS THAT ARE DIFFERENT FROM THOSE PROVIDED BY THE FEDERAL LAW AS DESCRIBED IN YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLING.
FOR MORE INFORMATION REGARDING YOUR PROTECTIONS AGAINST SURPRISE BILLING OR TO LEARN ABOUT MAKING A COMPLAINT CONTACT OR VISIT:
Ohio Department of Insurance 50 W Town Street Suite 300, Columbus Ohio 43215
OREGON LAW MAY PROVIDE PROTECTIONS TO YOU AND ALLOW VERICI DX TO BILL YOU FOR AMOUNTS THAT ARE DIFFERENT FROM THOSE PROVIDED BY THE FEDERAL LAW AS DESCRIBED IN YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLING.
FOR MORE INFORMATION REGARDING YOUR PROTECTIONS AGAINST SURPRISE BILLING OR TO LEARN ABOUT MAKING A COMPLAINT CONTACT OR VISIT:
Department of Consumer and Business Services, Division of Financial Regulation
PENNSYLVANIA LAW MAY PROVIDE PROTECTIONS TO YOU AND ALLOW VERICI DX TO BILL YOU FOR AMOUNTS THAT ARE DIFFERENT FROM THOSE PROVIDED BY THE FEDERAL LAW AS DESCRIBED IN YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLING. FOR MORE INFORMATION REGARDING YOUR PROTECTIONS AGAINST SURPRISE BILLING OR TO LEARN ABOUT MAKING A COMPLAINT CONTACT OR VISIT:
Pennsylvania Department of Insurance
Address: 1326 Strawberry Square, Harrisburg, PA 17120
TEXAS LAW MAY PROVIDE PROTECTIONS TO YOU AND ALLOW VERICI DX TO BILL YOU FOR AMOUNTS THAT ARE DIFFERENT FROM THOSE PROVIDED BY THE FEDERAL LAW AS DESCRIBED IN YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLING.
FOR MORE INFORMATION REGARDING YOUR PROTECTIONS AGAINST SURPRISE BILLING OR TO LEARN ABOUT MAKING A COMPLAINT CONTACT OR VISIT:
Consumers covered under (i) fully-insured policies issued in Virginia, (ii) the Virginia state employee health benefit plan; or (ii) as self-funded group or plan that opted into the Virginia protections area also protected from balance billing under Virginia law. These protections may be different from the ones provided by the federal law as described in YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLING.
FOR MORE INFORMATION REGARDING YOUR PROTECTIONS AGAINST SURPRISE BILLING OR TO LEARN ABOUT MAKING A COMPLAINT CONTACT OR VISIT: The State Corporation Commission Bureau of Insurance
Address: Bureau of Insurance – SCC, P.O. Box 1157, Richmond, Virginia 23218
WASHINGTON LAW MAY PROVIDE PROTECTIONS TO YOU AND ALLOW VERICI DX TO BILL YOU FOR AMOUNTS THAT ARE DIFFERENT FROM THOSE PROVIDED BY THE FEDERAL LAW AS DESCRIBED IN YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLING.
FOR MORE INFORMATION REGARDING YOUR PROTECTIONS AGAINST SURPRISE BILLING OR TO LEARN ABOUT MAKING A COMPLAINT CONTACT OR VISIT:
WEST VIRGINIA LAW MAY PROVIDE PROTECTIONS TO YOU AND ALLOW VERICI DX TO BILL YOU FOR AMOUNTS THAT ARE DIFFERENT FROM THOSE PROVIDED BY THE FEDERAL LAW AS DESCRIBED IN YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLING.
FOR MORE INFORMATION REGARDING YOUR PROTECTIONS AGAINST SURPRISE BILLING OR TO LEARN ABOUT MAKING A COMPLAINT CONTACT OR VISIT:
Offices of Insurance Commissioner
Address: West Virginia Offices of the Insurance Commissioner P.O. Box 50540 Charleston, West Virginia 25305-0540
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The technical storage or access is strictly necessary for the legitimate purpose of enabling the use of a specific service explicitly requested by the subscriber or user, or for the sole purpose of carrying out the transmission of a communication over an electronic communications network.
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