You are protected from balance billing for:
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 cannot be balance 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.
The state of Georgia and the federal government both have laws to protect you from balance billing, though they are different. State rules apply only to fully insured commercial health insurance plans and some government plans. Federal rules may also apply to commercial health insurance in situations where you received healthcare services in another state, your health insurance is regulated by a state other than Georgia or the healthcare service you received is not regulated by the state law. Most of the differences between the state and federal laws are in the way the rules affect providers and health insurers, so you usually won’t need to worry about that. However, the grievance processes are different, as indicated on the government websites listed below.
Certain services at an in-network hospital, ambulatory surgical center or other facility
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 cannot balance bill you and may not ask you to give up your protections not to be balance billed. Under Georgia and federal law, this rule also applies to imaging centers, birthing centers and similar facilities, in addition to hospitals and ambulatory surgical centers. If you get other services at these in-network facilities, out-of-network providers cannot balance bill you, unless you give written consent and give up your protections.