Your Rights and Protections Against Surprise Medical Bills
Information about your protections from unexpected healthcare costs
The Therapy Network Physical Therapy is committed to helping our patients understand their healthcare
rights and protections.
Federal law protects you from certain unexpected medical bills, also known as surprise medical bills or
balance bills. When you receive emergency care or certain services from an out-of-network provider at
an in-network facility, you may be protected from being billed more than your health plan’s in-network
cost-sharing amount.
What Is Balance Billing?
When you receive healthcare services, you may be responsible for certain out-of-pocket costs, such as
copayments, coinsurance, and deductibles.
If you receive care from a provider or healthcare facility that is out of your health plan’s network, the
provider may charge you the difference between what your health plan agrees to pay and the full amount
charged for the service. This is called balance billing.
A surprise medical bill is an unexpected balance bill that can occur when you cannot control who
provides your care. This may happen when:
• You receive emergency care.
• You receive care 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 receive emergency services from an out-of-network
provider or facility, the most you can be billed is your health plan’s in-network cost-sharing amount,
including copayments, coinsurance, and deductibles.
You cannot be balance billed for emergency services. This includes certain services provided after your
condition has stabilized unless you provide written consent and give up your protections against balance
billing.
Certain Services at In-Network Hospitals and Ambulatory Surgical Centers
- When you receive services at an in-network hospital or ambulatory surgical center, some providers
involved in your care may be out of network.
In these situations, the most those providers may bill you is your health plan’s in-network cost-sharing
amount. This protection applies to services such as:
• Emergency medicine
• Anesthesiology
• Pathology
• Radiology
• Laboratory services
• Neonatology
• Assistant surgeons
• Hospitalists
• Intensivists
These providers cannot balance bill you or require you to waive your protections.
If you receive other services at an in-network facility, out-of-network providers generally cannot balance
bill you unless you provide written consent and voluntarily give up your protections.
You Are Never Required to Give Up Your Protections
You are not required to waive your protections against balance billing.
You are also not required to receive care from an out-of-network provider. Whenever possible, you may
choose a provider or facility that participates in your health plan’s network.
When Balance Billing Is Not Allowed, You Also Have These Protections:
- • You are only responsible for paying your share of the cost, such as the copayment, coinsurance, or
deductible you would pay if the provider or facility were in network.
• Your health plan will pay out-of-network providers and facilities directly when required.
• Your health plan generally must:
o Cover emergency services without requiring prior authorization.
o Cover emergency services provided by out-of-network providers.
o Base your cost-sharing amount on what it would pay an in-network provider or facility.
o Count any amount you pay for emergency services or covered out-of-network services
toward your deductible and out-of-pocket maximum.
Good Faith Estimates for Uninsured or Self-Pay Patients
If you do not have insurance or choose not to use your insurance for healthcare services, you have the
right to receive a Good Faith Estimate explaining the expected cost of your care before services are
provided.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you may have the right to
dispute the bill.
For questions about Good Faith Estimates, please contact The Therapy Network Physical Therapy before
receiving services.
Virginia Patient Protections
Virginia law provides additional protections related to certain surprise medical bills.
If you believe you have been incorrectly billed, you may contact:
Virginia State Corporation Commission
Bureau of Insurance
Phone: 1-877-310-6560
Website: https://scc.virginia.gov
Virginia Patient Protections
For more information about your rights and protections under the No Surprises Act, please review the
official U.S. Department of Labor resource:
Avoid Surprise Healthcare Expenses: How the No Surprises Act Can Protect You
https://www.dol.gov/sites/dolgov/files/ebsa/about-ebsa/our-activities/resourcecenter/publications/avoid-surprise-healthcare-expenses.pdf
You can also learn more about your rights or report a potential violation through:
No Surprises Help Desk
Phone: 1-800-985-3059