Your situation: You didn't know that your care was out-of-network
This action plan applies to you if:
- You got an unexpected medical bill
- You used health insurance
- You didn’t know the facility you went to was out of your health plan’s network
Not your situation?
Answer a few questions, and we’ll get you to the right place.
If your bill is for emergency room care, this isn’t the plan for you. Visit the emergency room care action plan for steps you can take to reduce your bill.
Action Plan
Sometimes, you are asked to give up your billing protections when you get care. If you didn’t give your consent, you may be able to appeal your bill. Here’s what you can do.
Check your paperwork to see if you signed a notice and consent form.
After you visit the emergency room, you may need post-stabilization care (services to stabilize your condition). Or you may need additional non-emergency care at an in-network facility.
In most cases, out-of-network providers at in-network facilities must get your consent via a notice and consent form to give you this care and charge you more than in-network cost sharing.
Signing this form means that you consent to give up your billing protections by getting care out-of-network.
You won’t get a notice and consent form if you got care at an out-of-network facility.
Learn about notice and consent forms
Providers must follow rules to get your valid consent.
If you signed this form but don’t have a copy, ask your provider for one.
If you signed a notice and consent form or if you switched health insurance and forgot to notify your provider before getting care, ask your provider for a lower bill.
Appeal the out-of-network bill if your provider needed your consent and you didn't give it.
Usually, providers must get your consent to charge you out-of-network rates for:
- Post-stabilization care outside your health insurance network
- Out-of-network care at an in-network facility
If your provider didn’t give you the form, and you were billed for out-of-network care, you can appeal the bill.
Learn about the appeal process on HealthCare.gov
If you think your provider isn't following the law, submit a complaint.
When you submit a complaint, you're still responsible for paying the amount listed as "What you owe" in your explanation of benefits. But submitting a complaint will help us ensure that you and other patients aren't over charged in the future.
Ask for a lower bill.
Providers (or their billing departments) can sometimes lower the price. They may also offer payment plans. Talk to your provider to learn about your options.
Get tips for talking to your provider
Ask for financial assistance.
Nonprofit hospitals must give financial assistance to eligible patients who can't afford to pay. If you got care elsewhere, they may still offer financial assistance.
Ask your health care facility's billing department about financial help.
Learn how to apply for financial assistance
Get help from outside resources.
Here are other resources to help you resolve your issue:
Consumer Assistance Programs
Consumer Assistance Programs may be able to give you advice for your specific case in the state you got care.
Patient advocates
Patient advocates can handle medical billing issues on your behalf.
Friends and family
And consider asking a loved one for help. They can advocate on your behalf if you're feeling sick or overwhelmed.
Before you schedule care again, look for an in-network health care provider.
Call your health insurance company or go on their website to search through their provider directory to find someone near you. In-network providers tend to be much more cost-effective than out-of-network ones.
Page Last Modified:
11/05/2024 03:38 PM