At Tourist SOS, we recognize the importance of clear communication regarding healthcare costs, especially when you're away from home. "Balance billing," often known as "surprise billing," occurs when you receive a bill for the difference between what your health plan agrees to pay and the full amount charged by a healthcare provider or facility. This situation typically arises with out-of-network services, where the provider or facility does not have a contract with your health plan.

​

Key Points About Balance Billing:

• Out-of-Network Services: If you use a provider or facility outside your health plan's network, you might be subject to balance billing. Out-of-network providers may charge more than in-network providers for the same services, which can lead to unexpected costs.

• Emergency Services Protections: You are protected from balance billing for emergency services, including emergency air medical services, from out-of-network providers. You'll only be responsible for in-network cost-sharing amounts, like copayments, coinsurance, and deductibles.

• In-Network Facilities: When receiving services from an in-network hospital or ambulatory surgical center, you're protected from balance billing for certain services by out-of-network providers, unless you explicitly give up these protections.

Your Rights and Protections:

• Direct Payment by Your Health Plan: For services where balance billing is not allowed, your health plan will pay out-of-network providers directly, based on in-network rates. You're only responsible for your share of the cost.

• Emergency and Out-of-Network Services: Your health plan must cover emergency services without prior authorization and must treat out-of-network emergency services as in-network, applying your payments toward your deductible and out-of-pocket limits.

• No Surprises Act: If you face an incorrect bill, the No Surprises Act gives you the right to appeal decisions and possibly take your dispute to an independent external reviewer.

• Assistance and Complaints: You can seek help or file complaints regarding surprise billing through the No Surprises Act Help Desk or your state’s Consumer Assistance Program.

 

Exclusions:

Please note that the protections under the No Surprises Act do not apply to ground ambulance providers. Also, if you have a limited benefit plan, these protections may vary.

​

Need Help?

If you believe you’ve been wrongly billed or have questions about your protections, Tourist SOS is here to assist. Contact our Patient Advocate team to discuss your claim in detail. We’re committed to ensuring your healthcare experience is as stress-free as possible, even when you're far from home.

This summary aims to demystify balance and surprise billing, providing you with the knowledge to navigate these situations confidently. For more detailed information or assistance, don't hesitate to reach out to Tourist SOS.