Your Rights and Protections Against Surprise Medical Bills

Some medical care simply can’t be planned, like if you have a severe car accident or heart attack. What happens if a responding ambulance is not in your health plan provider’s network? Can the ambulance service bill you at an out-of-network rate?

In scenarios like this, the No Surprises Act¹ offers protection from surprise medical bills from out-of-network providers.

What is the No Surprises Act?

The No Surprises Act provides protection from surprise medical bills and balance billing from out-of-network providers or facilities in the following scenarios:

• Emergency Services
• Non-emergency Services (from an out-of-network provider delivered as part of a visit to an in-network health care facility)
• Air Ambulance Services

What is balance billing?

If you receive care from an out-of-network provider (a provider that has not signed a contract with your health plan) apart from the above scenarios, they 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, sometimes called “surprise billing”. The full amount is likely more than the in-network costs for the same service and might not count toward a plan’s annual maximum out-of-pocket (MOOP) limit.

Am I required to sign a surprise bill protection form?

An out-of-network provider may ask you to sign a notice and consent form, also known as a surprise bill protection form. Signing this form waives your surprise billing protection. You aren’t required to provide permission and should not sign the form if you didn’t have a choice of health care providers when receiving care. You can only be balanced billed in the three scenarios above if you give the provider permission by signing a surprise bill protection form.

Review Your Rights and Protections Against Surprise Medical Bills to understand your rights.

How can I know if a provider is in my health plan’s network?

Receiving care from an in-network provider or facility may cost less. If you have a GuideStone^® health plan,² find in-network providers through any of these options:

• Visit MyHighmark.com.
• Install the My Highmark App.
• Call 1-866-472-0924 (the number on the back of your medical ID card).

Where should I go for care?

It may not always be possible to choose a specific provider during a medical emergency. However, you can know where to seek care based on medical needs, which can help you save money. Find practical examples of where to go for care via telemedicine, in-office visits, urgent care or an emergency room.

Money-saving Resources

At GuideStone, we’re here to help you reduce health care costs in every season of ministry. Find money-saving tips on how to save on prescription medications, make the most of preventive care and minimize out-of-pocket costs. For more information on GuideStone health plans, contact us at Insurance@GuideStone.org or 1-844-INS-GUIDE (1-844-467-4843), Monday through Friday, from 7 a.m. to 6 p.m. CT.

¹Title I (No Surprises Act) of Division BB of the Consolidated Appropriations Act, 2021 (CAA) amended title XXVII of the Public Health Service Act (PHS Act).

²Excluding Medicare-coordinating plans and Cigna International plans.

GuideStone welcomes the opportunity to share this general information. However, this article is not intended to be relied upon as legal advice or medical advice, diagnosis or treatment.