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 may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.


“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers 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.” This amount is likely 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.

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 may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balanced billed for these emergency services. This includes services you may get after you’re in stable condition unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

Certain Services at an In-Network Hospital or Ambulatory 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 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.

You are 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.

Maryland also provides various balance billing protections. In most instances, you cannot be charged more than your in-
network cost share amount for emergency and non-emergency services. For more information about your specific rights under Maryland law, visit Maryland Insurance Administration.

When balance billing isn’t allowed, you also have the following protections:

You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities 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 have been wrongly billed, contact the Centers for Medicare & Medicaid Services (CMS)

  • Centers for Medicare & Medicaid Services phone: 800-985-3059

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Our locations

1209 York Road,
Lutherville, MD, 21093
410-821-9490
Hours
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Saturday: 9:00am-1:30pm

301 Saint Paul Place
Professional Office Building
Suites 514 & 902
Baltimore, MD 21202
410-727-8380
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7106 Ridge Road
Rosedale, MD 21237
(410) 866-2022
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Friday: 8:00am-4:00pm
Saturday: 9:00am-1:30pm

3401 Box Hill Corporate Center Drive
Suite 202
Abingdon, MD 21009
410-569-0707
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Saturday: Starting August 24th, we are open every other Saturday between 8:00 am-12:30pm


111 Mt Carmel Rd #600
Parkton, MD 21120
410-329-6700
Hours
Hours:
Monday 8:30am - 6:00pm
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Optical Opens at 9:00am each day.

**Now open the 2nd and 4th Wednesday of each month effective July 10, 2024**

310 Main Street
Reisterstown, MD 21136
410-833-5515
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Mon: 8:00 am - 4:00 pm
Tues: 8:00 am - 6:30 pm
Weds: Now open the 2nd and 4th Wednesday of each month effective 7/10/24
Thurs: 8:00 am - 4:00 pm
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Sat (First and Third Saturday of the month): 8:00am - 1:00pm

21 Crossroads Drive
Suite 425
Owings Mills, MD 21117
443-738-4270
Hours
Tues & Thur: 8:00am-5:00pm
Effective 10/1/24, Dr. Nelson will be relocating to Lutherville every Tuesday.

901 Dulaney Valley Road
Suite 200
Towson, MD 21204
410-583-1000
Hours
Mon-Fri: 8am-4pm