1. What is "Balance Billing" (or "Surprise Billing")?

When you see a doctor or a Psychiatric-Mental Health Nurse Practitioner (PMHNP), you may owe certain out-of-pocket costs, such as a copayment, coinsurance, or a deductible. You may incur other costs or have to pay the entire bill yourself if you see a provider or visit a facility that is not in your health plan's network.

• "Out-of-network" describes providers that have not signed a contract with your health insurance 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 cannot control who is involved in your care—such as when you have a medical or mental health emergency, or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.

2. You are protected from balance billing for:

• Emergency Services: If you have an emergency medical or psychiatric condition and receive emergency services from an out-of-network provider, the most the provider may bill you is your plan's in-network cost-sharing amount. You cannot be balance billed for emergency services.

3. Your right to receive a "Good Faith Estimate"

Under the law, healthcare providers must give patients who do not have insurance, or who are choosing not to use their insurance (self-pay), an estimate of the bill for medical items and services.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like psychiatric evaluations, follow-up medication management sessions, or psychological testing.

• Your healthcare provider must give you a Good Faith Estimate in writing at least 1 business day before your medical service is scheduled. You can also ask your provider for a Good Faith Estimate before you book an appointment.

• If you receive a bill that is at least $400 more than your official Good Faith Estimate, you have the legal right to dispute the bill.

• Always save a copy, screenshot, or printout of your Good Faith Estimate for your records.

4. What to do if you believe you have been wrongly billed:

If you receive a bill that you believe violates these protections, or if your bill is $400 or more above your Good Faith Estimate, you can contact the federal No Surprises Help Desk at 1-800-985-3059 or file an official complaint online at www.cms.gov/nosurprises.

In Pennsylvania, you may also file a consumer complaint or seek clarification directly through the Pennsylvania Insurance Department or the Office of Attorney General Bureau of Consumer Protection.