Your Rights and Protections Against Surprise Medical Bills
Coverage clarity, cost transparency.
As of January 2022, federal and state laws protect you from unexpected medical bills when you receive emergency care or certain services from out-of-network providers at in-network facilities.
What is Surprise or Balance Billing?
When you visit a healthcare provider, you typically pay standard out-of-pocket costs—such as copays, deductibles, or coinsurance. But if that provider is out-of-network, you may be billed for more than your health plan covers. This is known as balance billing, or surprise billing, and it can lead to significantly higher costs.
You may encounter surprise bills in situations where you can’t control who provides your care—like emergencies or treatment from specialists (e.g., anesthesiologists or radiologists) at an in-network facility.
When You’re Protected
You are protected from balance billing in the following cases:
Emergency Services
If you receive emergency care from an out-of-network provider or facility, you will only be charged your in-network cost-sharing amount.
You cannot be balance billed for emergency care, including services received after your condition is stabilized—unless you give written consent to waive your protections.
Services at In-Network Hospitals or Ambulatory Surgical Centers
Even at in-network facilities, some services may be provided by out-of-network professionals. These providers are not allowed to balance bill you or ask you to waive your protections.
This includes services such as:
- Emergency medicine
- Anesthesia
- Pathology
- Radiology
- Laboratory services
- Neonatology
- Assistant surgeon
- Hospitalist and intensivist services
For other services, you may only be balance billed if you give written consent. But you are never required to waive your balance billing protections.
Ohio Balance Billing Law
Ohio’s law (OCR 3902.50 to 3902.54) complements the federal No Surprises Act and includes two key differences:
- Ground Ambulances: Ohio law provides balance billing protections for ground ambulance services. The federal law does not.
- Plan Type: Ohio’s law applies to fully-insured health plans, while the federal law covers both fully-insured and self-insured plans.
Additional Protections
When balance billing is prohibited:
- You’re only responsible for in-network cost-sharing amounts (e.g., deductibles, copays, coinsurance).
- Your health plan must pay the out-of-network provider or facility directly.
- Your health plan must:
- Cover emergency care without requiring prior authorization
- Pay out-of-network providers for emergency services
- Base your cost-sharing on in-network rates and show this on your Explanation of Benefits (EOB)
- Count your payments toward your deductible and out-of-pocket maximum
If You Think You’ve Been Wrongly Billed
If you believe you’ve received a surprise bill in error, we’re here to help.
Contact Fisher-Titus:
Central Business Office Director
Phone: 419-660-4848
Or contact the federal help desk:
No Surprises Help Desk
Phone: 1-800-985-3059
www.cms.gov/nosurprises/consumers
Ohio Department of Health:
Phone: 1-800-342-0553